Vice President, Payor Contracting

Healthcare Outcomes Performance Company•Phoenix, AZ

About The Position

The Vice President, Payor Contracting serves as the contracting liaison between contracted payors and providers, building and maintaining effective relationships with internal and external customers. The role leads payor contract analysis and negotiations on behalf of providers, covering rates, payment methodologies, contract language, and value-based payment programs, while following internal contract review, approval, and signature controls. The position develops maintainable payor reimbursement analyses to establish a baseline for strategies that maximize health plan reimbursement and ensure payment integrity. It researches and recommends payor contracting opportunities in new and existing geographic service areas, ensures compliance in business and contractual relationships, and communicates trends or potential issues to market leadership and the HOPCo management team. It also leads infrastructure and analysis for strategic work such as rate transparency, payment validation, coordination with Revenue Cycle Management, and payor contracting strategy, including a value-based care glidepath. Other duties may be assigned. The position requires a bachelor's degree in Business, Mathematics, Finance, or Healthcare Administration; 7–10 years of related experience; comprehensive analytical and negotiating skills; and a successful track record supporting payor contract negotiations. The role calls for knowledge of provider financial issues, payor reimbursement, managed care contracting, managed care products and services, medical cost trend analysis, physician contracts, utilization, costs, and regulatory requirements. Strong communication, critical-thinking, problem-solving, analytical, organizational, and interpersonal skills are required, along with advanced computer skills and the ability to work independently and collaboratively, manage multiple projects, and meet tight deadlines. The work environment is a normal office environment or remote, with some travel within the community. Physical demands include sitting and standing, some bending and stretching, and manual dexterity for calculator and computer keyboard use. The job holder must adhere to HOPCo's mission, vision, and values and complete OSHA safety training.

Requirements

Bachelor's degree in Business, Mathematics, Finance, or Healthcare Administration.
7–10 years of related experience.
Proven working knowledge of provider financial issues, complex contracting options, financial and contracting arrangements, and regulatory requirements.
Comprehensive analytical and negotiating skills, with a successful track record supporting payor contract negotiations.
Familiarity with managed care products and services and medical cost trend analysis, including analysis of physician contracts, utilization, and costs.
Prior experience working with managed care contracting modeling.
Familiarity with managed care concepts, practices, and procedures.
Strong communication, critical-thinking, problem-resolution, and interpersonal skills.
Solid understanding of industry dynamics.
Ability to problem-solve and make recommendations.
Ability to stay on task with minimal supervision.
Excellent critical-thinking, troubleshooting, and analytical skills.
Knowledge of payor reimbursement, managed care contracting, and market and industry dynamics.
Strong verbal and written communication skills.
Strong organizational skills and careful attention to detail.
Advanced computer skills.
Ability to analyze problems and interpret information.
Ability to prioritize and reprioritize as necessary.
Ability to work independently and as part of a team.
Ability to multitask, manage multiple projects, and meet tight deadlines.
Acknowledge and adhere to HOPCo's mission, vision, and values.
Complete OSHA requirements and training, including safety training.

Responsibilities

Develop and maintain positive, effective relationships with internal and external customers.
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.
Follow 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 reimbursement-maximization strategies and payment integrity.
Research and recommend payor contracting opportunities in new and existing geographic service areas to executive leadership.
Ensure compliance in business and contractual relationships.
Identify and communicate trends and potential issues to market leadership and the HOPCo management team.
Lead development of infrastructure and analysis for strategic projects, including rate transparency, payment validation, coordination with Revenue Cycle Management, and payor contracting strategy, including the value-based care glidepath.
Perform other duties and responsibilities as assigned.