Directs payer contracting including portfolio, performance, execution, coordination, and implementation of risk and fee-for-service arrangements for facility, physician, Carilion Consolidated Lab, and ancillary agreements. Directs and manages price modeling, hospital contract modeling, performance monitoring and auditing. Supports multiple highly variable priorities with aggressive timelines to ensure maximum revenue to Carilion entities. In addition, ensures that pricing proposal terms fall within the approved pricing strategy. Provides leadership for the effective and efficient operation of these services and ensures that the activities and goals of these services are aligned with the business plan for Carilion Patient Financial Services Division and Carilion Clinic. Facilitates the implementation of new processes and programs on a cross-department organizational structure. Facilitates the linkage between the financial and clinical areas for managed care contracting.

• Directs analysis and contracting of risk and non-risk contractual arrangements (including reimbursement and contractual language) between Carilion Clinic, owned and affiliated hospitals, Carilion Consolidated Labs, ancillaries, Physicians (medical groups) and third party payers for the provision of health care services to member/patients. Payers include Commercial Insurance, Medicare Managed Care, Medicaid Managed Care, Third Party Administrators, Workers' Compensation and Employers under Direct Contracts.
• Executes and monitors a payer performance and accountability structure which will administer, track and resolve contractual performance and business activity supporting the ability to maximize organization revenue, growth and retention.
• Achieves annual and periodic goals for significant statistical indicators of revenue cycle performance including the management of hospital write-offs due to no authorization, medical necessity denials, or other reasons for writing-off any portion of an account.
• Oversees the Contract Management area to ensure Carilion is obtaining maximum reimbursement allowed by payer.
• Coordinates development of all quality and operational indicators that are tied to CHS' contractual performance with the goal of maximizing Carilion's revenue through the successful attainment of these targets.
• Manages solving problems and any issues that subsequently arise because of these contracts.
• Works with managers to perform analyses and reviews related to the revenue cycle to identify issues, investigate problems, and develop, monitor, implement and evaluate effective solutions.
• Reviews and addresses with payers, clinical staff, and the billing staff any trends in payment policies or clinical policies of th payers that have a negative impact on Carilion's reimbursement.
• Works cooperatively with CHS directors and managers to ensure coordination of revenue management projects and programs with the daily work requirement of operations staff.
• Works with staff and third party agencies in the areas of program development, contract compliance, training, and quality improvement.
• Serves as CHS' resource for managed care information.
• Recognizes and acts on opportunities for growth and improvement to advance Carilion goals. Uses project management principles to accomplish goals, seeks out appropriate resources and proactively anticipates change within the market, industry and organization. Aligns services with the mission and vision of Carilion. Translates Carilion goals into department specific objectives and priorities.
• Establishes, manages, evaluates, and maintains the execution of the payer relationship to ensure continual improvement of relationship, maximum growth of volume and revenue, and risk protection for Carilion's entities.