Vice President, Payor Contracting

Healthcare Outcomes Performance Company • Phoenix, AZ

1d • Hybrid

About The Position

The Vice President, Payor Contracting will develop and maintain positive, effective relationships with internal and external customers and serve as the contracting liaison between contracted Payors and providers. This role will lead contract analysis and negotiations with Payors on behalf of providers, including rates, payment methodologies, contract language, and value-based payment programs. The position requires leading the development of Payor reimbursement analyses to maximize health plan reimbursement and ensure payment integrity, as well as researching and recommending payor contracting opportunities to executive leadership. Ensuring compliance in all business and contractual relationships and communicating trends and potential issues to market leadership and HOPCo management are key responsibilities. The role also involves leading the development of infrastructure and analysis for strategic projects such as rate transparency, payment validation, and coordination with Revenue Cycle Management and payor contracting strategy, including value-based care glidepath. The job holder must demonstrate current competencies for the job position.

Requirements

• 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.
• 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 of payor reimbursement.
• Managed care contracting.
• Market and industry knowledge.
• Strong verbal and written communication skills.
• Strong organizational skills and careful attention to detail.
• Advance computer skills.
• Ability to analyze problems and interpret information.
• Able and to prioritize and reprioritize, as necessary.
• Ability to work independently, and as part of a team.
• Ability to multi-task, manages multiple projects, and meets tight deadlines.
• HOPCo Mission, Vision and Values must be acknowledged and adhered to.
• OSHA Requirements and training to include: Safety Training

Responsibilities

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Executive