Vice President Payer Relations
|Job Title||Category||Location||Job Type||Posted|
|Vice President Payer Relations||Accounting/Finance/Billing||Miramar, FL 33025||Full-Time||03-12-2021|
The Vice President of Payer Relations is responsible for all aspects of payer relations and contracting including payer contract negotiation and implementation for VITAS Healthcare. This position is responsible for leading the payer relations function responsible for all payer contract negotiations with new and existing third-party payers, including but not limited to commercial insurance companies, Medicare advantage plans, Medicaid managed care plans, other governmental payors, and Worker’s Compensation programs.
The leader will foster professional relationships with private and public payor executives and serve as the principal liaison between VITAS Healthcare and payors. This individual will also be responsible for representing the interests of VITAS Healthcare in discussions with other affiliated health systems or clinical partners in discussions related to managed care. Additionally, this individual will participate in and support the development of managed care strategies and initiatives to adapt to ongoing healthcare payment reforms and evolving payment methodologies.
- In collaboration with leadership, identifies appropriate contracting and re-contracting opportunities and initiates discussions with key constituents.
- Creates and maintains high level contacts with existing and potential contracting partners, state Medicaid agencies and hospice associations.
- Collaborates with managed care organizations and internal stakeholders to gain a thorough understanding of payer-specific requirements, reimbursement logic, and limitations. Ensures contracting efforts remain aligned with strategic plan/goals.
- For new relationships or service lines, performs business and market analysis to determine viability of contracting.
- Leads contract discussions with managed care organizations, including rate and language negotiations in accordance with established guidelines. Leads development of rate and language proposals. Collaborates with internal staff on modeling of rate proposals. Ensures contract terms can be administered and monitored in a cost effective manner.
- Effectively interfaces with management, finance, clinical, operations, and administrative staff to ensure contract negotiations are completed in accordance with critical dates and within approved financial parameters.
- Manages all aspects of the contract life cycle. Collaborates to assemble and gain an understanding of payer specific data, operational issues, and business review. Implements executed contracts, communicates contract changes internally, maintains appropriate documentation, reviews contract performance reports and makes appropriate recommendations.
- Develops and maintains effective working relationships across all levels (both executive and mid-management) of payer organizations (e. g. Contracting/Network Management, Provider Relations, Medical Management, etc.).
- Responsible for developing, coaching and leading a team of 5 direct reports responsible for contracting and payer relations for a wide ranging portfolio of agreements with third party payers in multiple markets.
- Facilitates problem solving of escalated contractual and operational issues through collaboration with managed care organizations and internal stakeholders. Identifies and communicates opportunities for process improvement with managed care organizations and internal stakeholders.
- Coordinates with analytical team to ensure contractual terms, including payer-specific requirements, reimbursement logic, and limitations are understood and appropriately included in any modeling systems. Serves as the expert on all terms of the payer contract for both internal and external parties.
- Participates in special projects as needed, including evaluating feasibility of program development as it pertains to payer operational requirements and reimbursement policies.
- Stays abreast of changing healthcare landscape to maintain an awareness of competitor services and reimbursement models, as well as opportunities for improvement in the financial and operational components of managed care contracts. Leads discussions pertinent to contract performance, market changes, market intelligence, and strategic decision-making.
- Monitors contract performance to identify reimbursement issues and ensure payer is complying with all contract provisions, via tracking of performance through a variety of means, including an audit of current performance via claims review, reports, etc.
- Establishing and operationalizing the provider credentialing process.
- Maintains up-to-date expertise and knowledge of hospice billing laws, rules, regulations, and developments necessary for the organization to make informed business decisions. Collaborate with legal counterparts to ensure optimal contract language is obtained and in accordance with Managed Care guidelines.
- 10+ years of experience evaluating, interpreting, & negotiating insurance contracts, and applying contract methodologies to meet the organization’s strategic plans.
- Deep understanding and working knowledge of managed care industry, market trends, payer customer types, various reimbursement structures and associated dynamics; established relationships with major insurers preferred.
- Experience with leading company-wide initiatives a must, including ability to bridge across divisions and between Support Center and field teams.
- Knowledge of hospice strongly preferred.
- Exceptional verbal and written communication skills
- Proficient in the use of desktop applications such as Word, Excel, and Power Point.
- Experience in building sustainable partnerships between payers and providers.
- Approximate percent of time required to travel: 50%.
- Bachelor’s degree in accounting, business administration or related field from an accredited college or university or equivalent experience required.
- EOE/AA M/F/D/V