VP Payer Relations & Clearinghouse Operations

Waystar • Atlanta, GA

391d

About The Position

The Vice President of Payer Relations at Waystar is responsible for developing innovative payer strategies and managing relationships with insurance carriers to enhance the company's financial performance. This role involves overseeing the clearinghouse operations, ensuring compliance with industry standards, and driving new partnerships that create value for clients. The VP will also lead initiatives to improve data exchange with payers and manage the financial aspects of the clearinghouse.

Requirements

• 10+ years industry experience with progressive leadership responsibility in healthcare organizations.
• 5+ years partnering with payers to deliver innovative healthcare information technology solutions.
• Demonstrated track record of being an accomplished executive, ideally with healthcare system experience.
• Extensive strategic planning and budget formulation skills at an executive level.
• Complex analytical and problem-solving skills.
• Strong leadership skills and effective team building capabilities.
• Dedication to excellence and innovation regarding continuous quality improvement.
• Knowledge of local, state, and national healthcare markets and emerging trends.
• Excellent written, verbal, and listening communication skills.

Nice To Haves

• Master's Degree in a related field or equivalent combination of education and experience.
• Experience with electronic health records (EHRs) and other healthcare technology platforms.
• Knowledge of coding and billing practices.
• Experience with revenue cycle management including payer relationships.

Responsibilities

• Oversee the entire clearinghouse operation, including EDI and API data exchange related to the revenue cycle.
• Ensure adherence to industry standards and regulatory requirements, such as HIPAA and CMS regulations.
• Monitor key performance indicators (KPIs) to measure efficiency and identify areas for improvement.
• Implement and maintain quality control measures to minimize errors and ensure accuracy.
• Manage staff and resources to ensure optimal productivity and efficiency.
• Develop and maintain strong relationships with payers, including health insurance companies, managed care organizations, and government agencies.
• Create new, mutually beneficial data exchanges that drive value for providers and health insurance companies.
• Negotiate contracts and agreements with payers to ensure favorable terms and conditions.
• Resolve disputes and claims denials with payers promptly and effectively.
• Stay informed about payer policy and procedure changes and implement necessary adjustments.
• Select, implement, and manage the clearinghouse's technology infrastructure, including software and hardware.
• Ensure the security and integrity of patient data and other sensitive information.
• Stay updated on industry trends and technologies and explore opportunities for innovation.
• Develop and manage the clearinghouse's budget.
• Identify cost-saving opportunities and implement strategies to improve financial performance.

Benefits

• Competitive total rewards (base salary + bonus, if applicable)
• Customizable benefits package (3 medical plans with Health Saving Account company match)
• Generous paid time off starting at 3 weeks + 13 paid holidays including 2 personal floating holidays
• Paid parental leave (including maternity + paternity leave)
• Education assistance opportunities and free LinkedIn Learning access
• Free mental health and family planning programs, including adoption assistance and fertility support
• 401(K) program with company match
• Pet insurance
• Employee resource groups

What This Job Offers

• Job Type: Full-time
• Career Level: Executive
• Industry: Construction of Buildings
• Education Level: Master's degree
• Number of Employees: 501-1,000 employees