University of Maryland Faculty Physicians-posted 3 months ago
Senior
Hybrid • Baltimore, MD
5,001-10,000 employees
Ambulatory Health Care Services

Reporting to the Chief Executive Officer (CEO), the Vice President, Managed Care and Value Based Contracting serves as FPI's point person for payer contracting and operational payer related issues (Federal, State and delegated) as well as managing all activities and aspects required for the organization to meet regulatory requirements for clinical quality reporting in collaboration with departmental leadership. Performs ongoing payer assessments and analyzes impact to FPI. Oversees payer relationships, contract negotiations, compliance, optimization of payer agreements, and the implementation of value-based programs. Develops and executes contracting strategies, managing relationships with payers, and ensuring successful integration of value-based initiatives. Plans for the successful execution of all FPI practice projects related to EQIP, ECIP, MD PCP, PCMH and MIPS program registration and attestation for all eligible clinicians. Serves as central contact to coordinate FPI payer contracts and UMSOM clinical department business development initiatives. Establishes collaborative relationships with SOM clinical department leadership and the UMMS office of managed care. Partners with executive leadership in setting strategic goals and aligning the quality vision for the organization while ensuring financial health.

  • Serve as point person for payer contracting and operational payer related issues.
  • Manage activities required for regulatory compliance in clinical quality reporting.
  • Perform ongoing payer assessments and analyze impact to FPI.
  • Oversee payer relationships, contract negotiations, and compliance.
  • Optimize payer agreements and implement value-based programs.
  • Develop and execute contracting strategies.
  • Plan for execution of FPI practice projects related to EQIP, ECIP, MD PCP, PCMH, and MIPS.
  • Coordinate FPI payer contracts and UMSOM clinical department business development initiatives.
  • Establish collaborative relationships with clinical department leadership and managed care office.
  • Partner with executive leadership to set strategic goals and align quality vision.
  • MBA or MHA in related field combined with minimum ten years of managed care experience.
  • Minimum 7 years of leadership experience.
  • Experience with payer contracting and/or credentialing required.
  • Knowledge of back and front office operations.
  • Knowledge and understanding of FPI contracts.
  • Knowledge of inpatient, critical care, emergency and/or outpatient procedures.
  • Current knowledge of Athena IDX/EPIC or similar software.
  • Knowledge of ICD-10 and CPT coding.
  • Strong customer service skills.
  • Experience with provider enrollment including NPPES, PECOS, and payer credentialing processes preferred.
  • Total rewards package that supports health, life, career, and retirement.
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