This position exists to provide strategic leadership to the Head of Revenue and the Executive team with respect to health funder / payer contracting.

This role is responsible for payer: negotiations; relationships; contract compliance; and payer funding modelling. This position works closely with hospital operational leaders and the strategy team to drive innovative models of care, provides advice with respect to financial modelling impacts and secures appropriate funding to support growth of services.

This position acts in an advisory role to the Head of Revenue regarding industry reforms and legislative changes and represents Calvary on external committees, forums and panels, as required.

 

Some of your responsibilities will include:

• Leading all health fund and compensable funder negotiations across Calvary's network of Private Hospitals
• Collation, production and analysis of the data and information for an upcoming health fund negotiation / public-private partnership agreements
• Collaborating with the National Financial Management Accountant to advise on health fund and revenue cycle management matters for budgeting and forecasting
• Act in an advisory capacity to the National Revenue Cycle team in the development of initiatives that reduce revenue leakage, improve efficiency, claims accuracy, and improve revenue outcomes.
• In conjunction with the National Manager Revenue Cycle, review outcomes of health fund audits and develop strategies together to drive reductions in auditable claims
• Review outcomes of internal billing and coding audits and develop strategies to improve coding and billing quality
• Effectively drive health fund negotiations achieving commercially sound outcomes in line with budget expectations
• Lead funding modelling analysis ensuring completeness and accuracy of data modelling and consistency of data models with contractual terms, conditions and billing rules
• Influence contract negotiations outcomes to ensure outcomes align with Calvary’s negotiation principles and strategic intent
• Develop strong relationships with health funders / payers that deliver mutually beneficial outcomes and strategic partnerships to support innovation and value-based contracting
• Work collaboratively with the hospital operations teams, the strategy team and payers to develop models of care that deliver financially responsible, high quality services

 

• Tertiary qualification in Finance, Business or Management.
• Minimum of five (5) years’ experience in a senior health fund contract manager role.
• Deep understanding of the private health industry macro environment, including challenges and opportunities created for hospital operators and broader industry reforms.
• In depth understanding of public funding models.
• Highly developed negotiation skills and interpersonal skills.
• Demonstrable skills in developing strategic partnerships both externally and internally.
• Highly developed written and verbal communication skills.
• Advanced analytics skills, strong experience in defining information requirements and capacity to analyse and integrate information from diverse sources.
• Strong IT skills relevant to this type of role.
• Ability to work within tight deadlines

 

For further information please contact Alison Jeanne, Head of Procurement and Revenue at: Alison.Jeanne@calvarycare.org.au

 

 

 

At Calvary, our staff matter. 

 

Join our team, learn with purpose and drive positive impact in one of Australia’s largest healthcare providers across Public and Private Hospitals, Residential Aged Care and Home Care. 

 

With over 130 years’ experience and 18,000 staff and volunteers, we offer an inclusive and welcoming culture where you are valued, drawing on your own strengths, identity and background alongside a team of professionals who care for our patients, residents and clients.

 

Your benefits: