Description

Job Summary (Summary of the basic functions of the position)

The Sr. Vice President of Managed Care is responsible for providing the vision, leadership and management of payer contracting by maximizing reimbursements, validating compliance, and building relationships in order to strengthen U.S. Dermatology Partners’ standard of excellent patient care. 

This position is responsible for interfacing directly with contracted payers on financial and operational issues on behalf of the organization’s providers. The role involves complicated, high dollar, financial, operational, and legal issues and drives operational performance through improved revenue collection. This includes building focused relationships with payers and working with many stakeholders across the U.S. Dermatology Partners enterprise.

Duties and Responsibilities (Responsibilities necessary to accomplish job functions)

• Responsible for defining and achieving targeted revenue and earnings objectives for the business
• Provides subject matter expertise on legislation, regulation, and accreditation standards related to managed care programs as well as other insurance laws and regulations
• Quickly gains an understanding of the current contracts and closes out open negotiations
• Develops and prioritizes target list of payers
• Plans, directs, and coordinates contract language, rate pricing, negotiations, revenue reconciliation, and payer relationship management
• Leads the design, development, and distribution of database tools and applications to efficiently measure, monitor, and/or forecast structure and performance of payer contracts
• Provides input into the budget process
• Determines reporting and benchmarking reports and audiences
• Builds strong relationships with key constituents throughout the organization especially with clinical leadership, senior leadership and the revenue cycle function
• Controls expenses while meeting service requirements
• Responsible for operationally integrating new entities into the existing portfolio

Qualifications

Experience Requirements

• Ten (10) or more years of progressively more responsible management experience
• Demonstrated experience in the managed care environment with emphasis on physician clinical operations or finance

Knowledge, Skills and Abilities Requirements

• Knowledge of managed care, billing, and operational issues in a medical center environment is essential
• Professional level of knowledge in business and health care administration
• In depth knowledge of managed care concepts, including value-based contracting
• Strong knowledge of State and Federal laws that apply to managed care
• Strong understanding of finance, information systems, marketing and clinical operations processes including in-depth knowledge of the regulatory environment, provider community, and payers in the new markets
• Detail oriented, professional attitude, reliable and able to provide concise answers to C-Suite personnel on Managed Care matters
• Management and organizational skills to support the leadership of this function
• Ability to follow or provide verbal & written instructions with sufficient grammar and spelling skills to avoid mistakes or misinterpretations
• Interpersonal skills to support customer service, functional, and team mate support needs
  • Able to communicate effectively in English, both verbally and in writing
• Mathematical and/or analytical ability for basic to intermediate problem solving
• Intermediate to advanced computer operation
  • Proficiency with Microsoft Excel, Word, and Outlook
• Specialty knowledge of systems relating to job function
• Knowledge of state and federal regulations for this position; general understanding of HIPAA guidelines

Supervisory Responsibilities:

• No supervisory duties