VP Payor Relations
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Overview
Job Description
Position Summary
We are seeking a strategic thinker and excellent negotiator for a hands-on role in payer contracting and reimbursement strategy across our multistate medical practice. This role is critical to ensuring optimal financial performance, sustainable growth, and strong relationships with Payors. This individual also responds to Payor inquiries, escalated claims and credentialing issues, and is a resource to communicate Payor policy across the organization. Position reports to the Chief of Payor Relations and Contracting.
Key Responsibilities
- Contract Strategy & Negotiation
- Conduct negotiations with commercial insurers, Medicare Advantage plans, Medicaid MCOs, and other payers.
- Develop and execute contracting strategies that align with organizational goals and market dynamics.
- Analyze reimbursement models and propose innovative contracting arrangements.
- Understand and negotiate both ideal economic and non-economic contract terms
- Financial Analysis & Modeling
- Evaluate contract performance, rate structures, and utilization trends.
- Collaborate with finance and analytics teams to model financial impact of proposed agreements.
- Monitor Payor compliance and identify opportunities for revenue optimization.
- Meet goals for revenue enhancement
- Stakeholder Collaboration
- Partners with executive leadership, legal, revenue cycle, and clinical operations to align Payor strategies.
- Serve as liaison between the organization and Payor representatives.
- Educate internal stakeholders on contract terms, reimbursement policies, and Payor trends.
- Work with operations team to optimize Merit-based Incentive Payment System (MIPS) and value performance plans
- Market Intelligence & Regulatory Awareness
- Recommend and use outside services to provide market payment data and use to develop company negotiation strategies
- Stay abreast of federal and state regulations affecting reimbursement and Payor contracting.
- Monitor competitive market activity and Payor behavior across multiple states.
- Provide strategic insights to inform expansion, acquisitions, and service line development.
Qualifications
- Bachelor's degree in finance, business, or health care or related field
- Track record of successful negotiations skills.
- Strong analytical, communication, and leadership skills.
- Preferable but do not require experience with health care Payor models including fee-for-service, capitation, bundled payments, and value-based care models.
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