Area Vice President - Payor Contracting

Advocate Health and Hospitals Corporation•Milwaukee, WI

1d•Hybrid

About The Position

The Area Vice President - Payor Contracting is responsible for developing and managing a portfolio of payer contracts to optimize revenue, margin, and growth in alignment with the organization's mission and strategic objectives. This role involves establishing and maintaining positive relationships with market payers, collaborating with internal stakeholders to define payer strategy, and overseeing financial analysis of contract performance. The position also includes managing risk-sharing agreements, interfacing with government relations, performing human resources responsibilities for staff, and developing budgets. The role requires adherence to the organization's Code of Ethical Conduct.

Requirements

Bachelor's Degree in Business, or Bachelor's Degree in Health Care Administration or related field.
Typically requires 15 years of experience in contractual, administrative, health insurance and operations related to managed care organizations, physician groups, hospitals and health insurance benefit plan designs.
Includes 10 years of management experience in the management of staff, budgets, and multiple managed care contracting functions.
Proven and extensive contracting technical skills; contract preparation and implementation, financial analysis and rate proposal development, and in depth knowledge of various reimbursement methodologies.
Ability to negotiate with excellent interpersonal, diplomatic, and problem solving skills.
Self motivated, with excellent written and verbal communication and presentation skills.
Proficiency in the use of Microsoft Office (Excel, Access, PowerPoint and Word) or similar products.
Ability to assess problems and effectively implement solutions.
Advanced skill in financial analysis with a track record of achieving financial targets.
Demonstrated experience in overseeing financial agreements with vendors, legal negotiations and contract finalization.

Responsibilities

Develops and manages a portfolio of payer contracts that optimize enterprise organization revenue, margin and growth in alignment with mission and strategic objectives.
Establishes and maintains positive, appropriate relationships with market payers.
Utilizes communication and organizational skills to work collaboratively and credibly with payers to achieve common objectives and assist in the resolution process related to any disputes.
Works collaboratively with internal stakeholders across all business units to define and achieve common payer strategy and reimbursement objectives.
Develops and executes communication plans to internal and external stakeholders related to payer relationships, negotiations, organizational contractual obligations, and developments in the managed care marketplace.
Works with the Vice President of Revenue Analytics to ensure financial analysis of payer contract performance and modeling projections based on alternate contract agreements with payers, adverse trends, etc., and then makes appropriate recommendations or conclusions for the enterprise.
Performs high level review and monitors financial aspects of existing managed care contracts.
Utilizes the financial analysis of reimbursement rates from Revenue Analytics for feedback on contract renewals, renegotiations or termination.
Makes recommendations regarding participation or non-participation with new or existing agreements and provide feedback to entire Aurora senior leadership regarding financial and/or operational issues with payers.
Works with Legal to ensure consistency and to the extent possible, standardization of contract terms.
Develops and manages the risk sharing and reconciliation process to manage financial guarantees related to payer and employers.
Interfaces with government relations related to any conflicting issues regarding Medicaid management with the State.
Performs human resources responsibilities for staff which include interviewing and selection of new employees, promotions, staff development, performance evaluations, compensation changes, resolution of employee concerns, corrective actions, terminations, and overall employee morale.
Develops and recommends operating and capital budgets and controls expenditures within approved budget objectives.
Responsible for understanding and adhering to the organization's Code of Ethical Conduct and for ensuring that personal actions, and the actions of employees supervised, comply with the policies, regulations and laws applicable to the organization's business.