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E01104 – Senior Vice President of Payor Relations
Position Overview: The Senior Vice President of Payor Relations directs contracting and relations with managed care organizations nationally that provide healthcare patient services. Develops long-term strategies and tactics for managed care contract review and analysis utilizing RCA’s market share, local facility dynamics and payer history including their alternative payment strategies.. Leads the initiation, negotiation, and execution of all payer contracts. Oversees the maintenance of relationships and issue resolution with managed care organizations including quality initiatives. RCA partner in payer credentialing for all clinicians as well as audit partnership with billing to ensure compliance. Maintains relationships with payers to act as liaison between payer and RCA billing when issues warrant. Ensures all contracts are compliant with governmental regulations. Responsible for the Management of the Payor Relations Department staff including hiring, training and oversight. Ensure that RCA is positioned nationally with payers as the provider of choice with annual increases to continue our national success.
- Sell RCA’s services to prospective and existing managed care clients with a focus on growing the business.
- Establish relationships with new and existing customers that can lead to increased revenue growth.
- Identify business opportunities with new and existing customers that can be memorialized into contractual commitments.
- Develops business relationships with key account decision makers and influencers at a Director/VP/C-Suite level. Manages RCA’s relationship with the account and acts as the primary point of contact within RCA for the account.
- Analyzes customer needs and strategic direction, collects intelligence on competition, and determines opportunities to improve contract profitability and strengthen RCA’s strategic position.
- Manages the contracting process including contract amendments, rate negotiation, rate approvals, language review, pay for performance standards, execution, and implementation of executed agreements both with the customer and internally.
- Monitors revenue and profitability trends and key account performance indicators to ensure results are being achieved.
- Completes reports on contract opportunities and progress in achieving assigned objectives.
- Timely responds to quality concerns through all involved, ensures communication with all departments regarding same.
- Ensure all clinicians across all markets are timely credentialed with all payers and ensure audit in place for same.
- Works collaboratively in markets with CEOs and Regional Vice Presidents regarding contracting in their regions and these executives are thoughtfully involved in every step of process and negotiation.
- Interacts with RCA billing department as needed to be knowledgeable of any issues with payers, and works with payers to help solve any problems needed to rectify payment delays and issues
- Maintains database of account contacts and key account information.
- Manages all staff for the Payor Relations Office including regional VPs, Contract Managers, Payor Relations Representatives, and Credentialing Officers.
- Provides strategic planning for the Payor Relations Office and oversee all projects, initiatives, and daily operations.
- Develops, oversees, and is responsible for key performance metrics for the Payor Relations Office.
- Manages single case agreement processes with payors/clients.
- Collaborates with internal stakeholders at RCA, including C-suite executives, senior VP’s, directors, etc.; and communicates Payor Relations Office’s strategic planning, payor relations/contracting updates, and payor trends.
- Collaborates with RCA’s Quality, Compliance & Licensure Offices to assure payors receive required data on Incident Reports and QOCs.
- Collaborates with the Chief Medical Officer on the clinical services and acts as the representative for the organization to all payors on RCA’s services and opportunities.
- Collaborates with the Business Development Team and the Facilities on client management and leverages relations with payors to manage and expand business.
Education and Experience:
- Bachelor’s degree from 4-year college is required in Business, Finance, Health Administration or related degree; masters preferred
- 10+ years’ work experience required; four in a Managed Care or health care provider organization.
- Demonstrated ability to deliver results and execute on business plans including ability to successfully negotiate annual increases with quality initiatives.
- Financial acumen with an understanding of financial models.
- Strong negotiation skills.
- Proactive strategist with ability to anticipate market changes and trends
- Demonstrated account management experience.
- Excellent oral and written communication skills
- Proficient in Microsoft Office Suite
Creating the New and Different: The ability to generate new ideas and breakthroughs requires vision, creativity, and broad interests and knowledge. Must also be able to speculate about alternatives, manage the innovation process and teams, and bring those ideas to market.
Impact and influence: Works effectively with and through others including those whom there is no formal authority.
Business Acumen: Ability to develop and administer multi-million budgets with a strong bottom-line mentality. Understands the levers that make the biggest impact.
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 would be expected up to 25% of the time.