Vice President, Payor Contracting
About this role
ESSENTIAL FUNCTIONS
• Develop and maintain positive, effective relationships with internal and external customers and serve as the contracting liaison between contracted Payors and providers. • Lead contract analysis and negotiations with Payors on behalf of providers including rates, payment methodologies, contract language and value- based payment programs in accordance with internal control processes for contract review, approval and signature. • Lead development of Payor reimbursement analyses that can be routinely updated and maintained as a baseline for strategies to maximize health plan reimbursement and ensure payment integrity. • Research and make recommendations to executive leadership in regard to payor contracting opportunities in new and existing geographic service area. • Ensure compliance in all business and contractual relationships • Identify and communicate trends and/or potential issues to market leadership and HOPCo management team. • Lead development of infrastructure and analysis for strategic projects including rate transparency, payment validation and coordination with Revenue Cycle Management, payor contracting strategy including value based care glidepath. • Other duties and responsibilities as assigned.
The job holder must demonstrate current competencies for job position.
EDUCATION
• Bachelor's Degree in Business, Mathematics, Finance or Healthcare Administration required.
EXPERIENCE
• Proven working knowledge of provider financial issues, complex contracting options, financial/contracting arrangements and regulatory requirements. • 7-10 years related experience and comprehensive level of analytic and negotiating skills with successful track record supporting contract negotiations with payors. • Strong communication, critical thinking, problem resolution and interpersonal skills. • Solid understanding of industry dynamics required.
REQUIREMENTS
• Familiarity with managed care products and services, medical cost trend analysis, including analysis of physician contracts, utilization, and costs. • Must have prior experience working with managed care contracting modeling. • Familiar with a variety of concepts, practices, and procedures in the field of managed care. • Must be able to problem solve and come forward with recommendations. • Must be able to stay on task with minimal supervision. • Excellent critical thinking, troubleshooting, and analytical skills.
KNOWLEDGE
• Knowledge of payor reimbursement. • Managed care contracting. • Market and industry knowledge.