System Director Contract Compliance

CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources CommonSpirit is committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community.

Job Summary 

The System Director, Contract Compliance is accountable for assessing managed care contract financial performance for CommonSpirit Health providers in assigned markets and payers to monitor and enforce contract compliance.  This role oversees contract compliance initiatives and develops strategies for revenue realization. 

The System Director, Contract Compliance is a key member of the Payer Strategy & Relationships leadership team and works with key stakeholders to develop, deploy and maintain system contract compliance strategies, tools and resources to enforce contract compliance and maximize the value of CommonSpirit Health’s payer contracts.

Essential Key Job Responsibilities

·       Lead payer contract compliance team through providing oversight, education, direction, development, and problem resolution. Ensure that all staff have a clear understanding of their roles and responsibilities and maximize the unique strengths and expertise of each team member to increase effectiveness and efficiencies. Promote positive environment to advance employee engagement imperatives.   

·       Design and deploy contract compliance strategic blueprint and implementation plan for all CommonSpirit Health divisions with a focus on leveraging relationships and contract expertise to maximize revenue realization. Develop, test and approve operational processes to manage, monitor and enforce compliance with managed care contracts.  

·       Provides education, guidance and recommendations regarding payment resolution and prevention processes based on contractual, policy, and regulatory expertise.

·       Apprise strategic partners of payer policies and protocols that pose a risk to the performance of payer contracts to support dispute measures and inform strategic planning efforts.

·       Assess and prioritize contract compliance opportunities escalated from multiple sources, provide direction and maintain visibility into all contract compliance projects and activities, and provide feedback to key stakeholders.

·       Oversee the identification, collection, and manipulation of data within multiple contract modeling tools, billing systems, and databases (e.g., Payment Integrity Compass, EPSI, EPIC, MediTract) and external sources (e.g., Medicare/Medicaid websites).

·       Explore avenues of internal process improvement feedback mechanisms to address any identified gaps or departmental deficiencies that may have an adverse financial impact at the division or system level of CommonSpirit Health.

·       Act as a critical liaison to negotiating teams for payment compliance and recovery for all CommonSpirit Health divisions which has a profound impact on maximizing the value of payer contracts.

• Bachelor’s degree Business Administration, Accounting, Finance, Healthcare or related field. Equivalent experience may be considered in lieu of degree.
• Minimum of ten (10) years of healthcare experience
• Minimum of five (5) years of progressive healthcare leadership experience
• Minimum of three (3) years of experience with payer reimbursement methodologies, payment/revenue integrity, revenue cycle and/or contract compliance
• Proven proficiency in contributing to profitability through detailed financial analysis and/or A/R oversight, trend management, budgeting, strategic planning, and healthcare operations
• High level of technical understanding and proficiency in Excel, Patient Accounting Systems, web-based applications, or other related applications
• In depth knowledge of payer policies and protocols and potential for revenue impact
• Ability to translate operational knowledge to identify unusual circumstances, trends, or activity and project the related impact on a timely basis
• Proficient in the review and enforcement of negotiated contract rates and terms in collaboration with revenue cycle partners
• Ability to effectively act as a critical liaison and advocate to identify and rectify contract compliance issues with managed care payers by leveraging relationships and contract expertise
• Ability to maintain working knowledge of health care systems, finance, revenue cycle, information systems, complex managed care concepts and processes, reimbursement methodology, contract operations, healthcare billing principles, contracting language, and legal principles
• Strongly prefer large healthcare system/hospital experience (revenue cycle)

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