[Hiring] Vice President, Payor Contracting @Healthcare Outcomes Performance Co. (HOPCo)

Role Description

• 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 areas.
• 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.

Qualifications

• Bachelor’s Degree in Business, Mathematics, Finance, or Healthcare Administration required.
• 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 a 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.
• Advanced computer skills.

Abilities

• Ability to analyze problems and interpret information.
• Able to prioritize and reprioritize, as necessary.
• Ability to work independently, and as part of a team.
• Ability to multi-task, manage multiple projects, and meet 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