President
: Job Details :

Position Overview: The Vice President of Payer Relations is a key RCA leader who will be responsible for overseeing the Company's entire contract portfolio, consisting primarily of commercial and Managed Medicaid contracts. This leader will serve as the payer contracting subject matter expert and lead strategy development to leverage existing relationships and opportunities for growth. This role will also lead the team in developing strategies to advance strategic partnerships, new care delivery/service reimbursement models, value-based agreement strategy and growth, and overall efforts to innovative payer strategies to maximize value for the patient, payer and RCA. The optimal candidate will bring a deep understanding of the managed care and commercial insurance space and have experience re-negotiating payer contracts as well as leading risk-based contracting strategies for healthcare services businesses. Lastly, this person will be a strong relationship builder and exceptional storyteller who enjoys working collaboratively and is excited to take initiative and offer thought leadership within a growing organization. KEY RESPONSIBILITIES Lead, manage, mentor and develop Payer Strategy team. Serve as the payer contracting subject matter expert and help evolve the Company's contract database. Ensure standardization and consistency in all payer contracting efforts to ensure compliance with company objectives and regulatory requirements. Manage financial risks and data-sharing challenges in risk-bearing reimbursement models. Optimize strategies to achieve positive financial and clinical outcomes through specialty bundles. Primary contact for payers related to contracting, but also quality of care concerns; strong focus on process, tracking and database management Strong partnership and interface with revenue cycle teams for troubleshooting payment and collection issues Directly engages with senior leadership team to design strategic initiatives that influence payer and employer strategies. Assist with creative positioning and partnerships in local healthcare ecosystems to access new channels and patient populations Evaluates innovative payer partnership opportunities to ensure alignment with RCA's strategies. Set the foundation to deliver, measure, and improve impact by deploying value-based care strategies; including constructing and evolving go-to-market messaging and elevating Company's value across critical stakeholders. Take a data-driven approach to contract assessment; use effective processes and technology to consolidate all relevant information in an effort to prioritize contracts across the organization. Ongoing review of company's existing payer relationships to identify opportunities for refinement and/or renegotiation. Leverage existing knowledge of the payer ecosystem to grow the company's presence in existing markets. Supervise the execution of new contracts and contract renewals to ensure maximum reimbursement, operational efficiency and compliance. Designs strategy and manages system participation and performance around innovative care models to ensure appropriate reimbursement models accompany program participation. Designs and implements reimbursement strategies for new services/care delivery models to optimize revenue and margin (telehealth, hospital at home, etc.) Collaborates with cross functional teams of Finance, Legal, Business Development and Operations areas to advance alignment and accountability in order to maximize the value of payer contracts for the patient, payer and RCA. Monitor emerging payer trends, new reimbursement methodologies, payer activity, products and delivery channels. SKILLS AND EDUCATION A bachelor's degree is required; a master's degree in business or healthcare administration is strongly preferred. 15+ years industry experience 10+ years progressive leadership responsibility and experience in large healthcare organizations 5-10 years strategic management of healthcare pricing, contract negotiation and healthcare economics in a complex, national or multi-regional healthcare system or health insurance environment Experience working with both provider and payer organizations is preferred. Experience in value-based reimbursement model development Demonstrated success in leading, implementing and managing financial performance of payer contracts. Competencies: Integrity: Upholds personal and professional ethics and values, taking into account the values of the organization and respecting the culture, beliefs and abilities of individuals. Job Knowledge: Understands duties and responsibilities, has necessary job knowledge, has necessary technical skills, understands company mission/values, keeps job knowledge current, is in command of critical issues. Communication: Communicates well both verbally and in writing, creates accurate and punctual reports, delivers presentations, shares information and ideas with others, has good listening skills. Problem Solving: Identifies problems, involves others in seeking solutions, conducts appropriate a analysis, searches for best solutions; responds quickly to new challenges Decision Making: Use effective approaches for choosing a course of action or developing appropriate solutions and/or reaching conclusions; take action consistent with available facts, constraints, and anticipated consequences. Collaboration: Nursing professionals must be able to work in collaboration with other health professionals and leaders from other disciplines. Work Environment: This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, and filing cabinets. The noise level in the work environment is usually moderate. Physical Demands: While performing the duties of this position, the employee is regularly required to talk or hear. The employee frequently is required to use hands to finger, handle or feel objects, tools or controls. The employee is occasionally required to stand; walk; sit; reach with hands and arms; climb or balance; and stoop, kneel, crouch or crawl. The employee must occasionally lift and/or move objects up to 25 pounds. Specific vision abilities required by this position include close vision, distance vision, color vision, peripheral vision and the ability to adjust focus. Travel: Travel is primarily local during the business day, although some out-of-the-area and overnight travel may be expected.