Director Contracting

About the Job

MedStar Health is seeking an experienced, strategic managed care professional to lead payer contracting and payer relations across our integrated healthcare system. This highly visible position serves as a trusted liaison among managed care organizations, hospital leadership, physicians, revenue cycle teams, finance, legal counsel, and billing partners.

The ideal candidate combines strong contract negotiation skills with a thorough understanding of healthcare reimbursement, payer operations, provider networks, clinical denials, and Maryland’s unique rate-regulated environment. If you enjoy solving complex problems, strengthening payer partnerships, and developing contracting strategies that support both patient access and organizational performance, this is an opportunity to make a meaningful systemwide impact.

Primary Duties and Responsibilities:

• Lead the negotiation, implementation, monitoring, and evaluation of managed care agreements for hospital, institutional, ancillary, and professional services, including contract language, reimbursement rates, and alternative payment arrangements.
• Build and maintain strong payer relationships while serving as the primary resource for contract interpretation, policy clarification, reimbursement concerns, claims issues, and operational challenges.
• Collaborate with finance, revenue cycle, legal counsel, clinical leadership, case management, physician advisors, administrators, and billing partners to resolve payer-related issues and ensure successful contract implementation.
• Conduct market, financial, utilization, and competitive analyses to identify contracting opportunities, strengthen provider networks, increase managed care utilization, and support the development of new services.
• Lead interdisciplinary contracting initiatives, RFP responses, package-pricing arrangements, payer negotiations, managed care improvement plans, and other strategic projects.
• Oversee clinical denial and appeal strategies, evaluate payer medical policies and utilization-management requirements, and develop executive reports that track denial trends, reimbursement issues, contract performance, and improvement opportunities.
• Educate physicians, leaders, residents, office staff, and other stakeholders regarding payer policies, contractual changes, managed care trends, reimbursement requirements, and operational procedures.
• Assess payer satisfaction, coordinate improvement initiatives, and oversee delegated credentialing activities to support regulatory compliance, timely reimbursement, and positive payer relationships.

Minimal Qualifications:

• Bachelor’s degree in business, healthcare administration, public health, finance, or a related field required.
• Graduate degree in Business Administration, Public Health, Health Administration, or a related discipline preferred.
• Five to seven years of progressively responsible experience in healthcare delivery systems, health insurance, payer contracting, or managed care.
• Demonstrated success negotiating complex healthcare contracts.
• Experience using information systems and data to strengthen administrative, financial, and operational oversight.
• Revenue cycle management experience preferred.

Knowledge Skills and Abilities

• Strong familiarity with healthcare provider networks and their underlying contractual arrangements.
• Understanding of financial and other incentives that impact managed care product design and service delivery.
• Understanding of the information requirements of the various stakeholders in the managed care systems including hospitals physicians and other providers and payers.
• Understanding of Maryland's rate regulated system under the jurisdiction of the Health Services Cost Review Commission.
• Knowledge of contract terms and an understanding of legal requirements including federal and state laws.
• Knowledge of traditional and innovative managed care products and an understanding of evolving reimbursement arrangements.
• High level problem solving skills.
• Ability to work under minimal supervision to recommend decisions that have impact on business units and bottom-line financials within organization.
• Demonstrated ability to work collaboratively to achieve results.
• Excellent verbal and written communication skills.

This position has a hiring range of

USD $114,004.00 - USD $219,960.00 /Yr.