VP, Payor Relations

Overview

The Vice President of Payor Relations will be responsible for executing the company’s managed markets position and value proposition, including both strategic relationships as well as contractual relationships with individual Managed Care/ Payor relations customers. In addition will act as a liaison to MPower’s sales teams.

Responsibilities

Strategic Planning & Leadership

· Responsible for the planning, development, direction and maintenance of outside third-party payor and provider contracting relationships.

· Develops a strategic plan for all insurance and value-based initiatives across the company. Monitors strategic plan for key milestones and works with Managed Care Professionals to ensure initiatives are met within specific timeliness.

· Assists in the maintenance and development of strategy and financial reporting requirements.

· Supports the development of population health opportunities and alternative reimbursement models.

· Exercises general day- to-day supervision over payor relations department staff engaged in contract negotiations with third party payors.

Contracting & Negotiations

· Analyzes proposed fee schedules, negotiates financial terms and contract language of managed care contracts.

· Projects and manages contracting initiatives and works with Managed Care Professionals to ensure goals and objectives are met.

· Engage in negotiations to ensure deliverables are met in a timely manner.

· Lead negotiator for major health plans and other third-party payors' contract negotiations.

· Lead contracting efforts with traditionally out-of-network providers, including ER, IOM, hospitalists, radiology, infusion, and anesthesia groups.

· Build, negotiate, and execute agreements to bring targeted providers into network and expand access.

· Identify, engage, and develop relationships with large provider organizations and specialty physician groups.

· Leverage deep knowledge of payer–provider dynamics and reimbursement strategies to secure favorable terms.

· Partner with leadership to design and implement strategies for high-priority provider contracting.

· Utilize industry connections, market intelligence, and targeted outreach to identify and secure contracting opportunities.

Operational Management & Reporting

· Conducts ongoing assessment and investigation of managed care payments and operational issues.

· Communicate results of information gathered, trends, concepts and processes to facilitate education, problem resolution and operational improvement.

· Develop presentation materials for internal and external meetings. This involves developing content for managed care strategies and major project initiatives.

Skills / Specialized Knowledge

· Pursuing work with little supervision or assistance; directing one's own efforts. Demonstrated ability to work independently and as part of a team.

· Advanced skills in organizational and workflow efficiency.

· Persuasively articulating one’s position, carefully listening to others' positions, and tailoring negotiation tactics to bring all parties together and reach desired outcomes; striking a balance between being firm and being willing to compromise; preserving long-term relationships by demonstrating fairness and searching for win-win solutions.

· Computer Proficiency in basic computer applications such as Microsoft Office {PowerPoint, Word, Excel), e-mail, and internet.

· Organizational and project management skills to handle projects.

· Ability to work through details of a problem to reach a positive solution.

· Excellent verbal, written and interpersonal communication skills.

· Superior analytical ability to evaluate data, make judgments and recommendations regarding strategies, tactics, operations, and budgets.

Qualifications

Qualifications

· Bachelor’s degree in healthcare Admin., Business Admin., Finance, Accounting; MBA or MHA preferred.

· 10 years of related experience including: years of financial and third-party payer contract management experience.

· Experience with PHO, physician, and hospital negotiators.

· Experience in resolving operational and/or compliance issues with third-party payors.

Other Requirements

· Must maintain professional appearance.

· Ability to be at work on a regular and consistent basis

Physical and Mental Demands

This position will spend long hours sitting and using office equipment and computers. The position may also entail light lifting of supplies and materials occasionally, up to and including 20 pounds in addition to reaching, stooping, standing, and walking. This position requires the ability to talk, hear, compare, compute, compile, copy, analyze, coordinate, synthesize, negotiate and communicate. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions.

Work Environment

Standard office working environment that may be busy and noisy at times