Vice President, Payor Contracting

ESSENTIAL FUNCTIONS 

• 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. 

EDUCATION 

• Bachelor’s Degree in Business, Mathematics, Finance or Healthcare Administration required. 

EXPERIENCE 

• 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. 

REQUIREMENTS 

• 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  

• Knowledge of payor reimbursement. 

• Managed care contracting. 

• Market and industry knowledge. 

SKILLS 

• Strong verbal and written communication skills. 

• Strong organizational skills and careful attention to detail. 

• Advance computer skills. 

ABILITIES 

• 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. 

ENVIRONMENTAL WORKING CONDITIONS 

• Normal office environment or Remote.  Some travel within community. 

PHYSICAL/MENTAL DEMANDS 

• Requires sitting and standing associated with a normal office environment. 

• Some bending and stretching required. 

• Manual dexterity using a calculator and computer keyboard. 

ORGANIZATIONAL REQUIREMENTS 

• HOPCo Mission, Vision and Values must be acknowledged and adhered to 

• OSHA Requirements and training to include: *Safety Training  

This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities and working conditions may change as needs evolve.