Vice President Payer Strategy

**This position can be based out of either Allentown, PA or Philadelphia, PA**

The Vice President Payer Strategy will be responsible for planning, directing, and coordinating the policies, goals and objectives related to contract language and rate pricing, negotiation strategy, and planning and execution. This leader will have an opportunity to have a positive impact on the profitability and future growth of an organization through the implementation of innovative and best practices related to payer contracting.

Essential Functions:

• Provides strategic leadership, financial and administrative oversight of payer contracting and operations.

• Leads the design, development, and distribution of database tools and application to efficiently measure, monitor, and/or forecast medical cost structure and performance of payer contracts.

• Develops a Contracting Model.

• Develops and prioritizes target list of payers

• Develops materials for meetings with payers

• Implements and maintains a contract administration system to include tracking of contract negotiation, implementation and renewal processes, billing and collecting related contract payments.

• Builds corporate knowledge of all financial aspects of government program reimbursement methodologies and prevalent reimbursement methodologies.

• Provides input into the budget process.

• Controls expenses while meeting service requirements.

• Recruits, develops and motivates staff.

• Initiates and communicates a variety of personnel actions including employment, termination, performance reviews, salary reviews and disciplinary actions.

• Plans, directs, and coordinates contract language, rate pricing, negotiations, revenue reconciliation, and payer relationship management.

• Holds primary responsibility for building expertise in provider contracting.

• Determines reporting and benchmarking reports and audiences.

• Builds strong relationships with key constituents throughout the organization especially with clinical leadership, senior leadership and the finance department.

• Provides innovation, be an industry leader and “raise the bar” in the department.

• Build an infrastructure that supports a strong Payer Contracting Department

• Create a Payer strategy for the Good Shepherd Rehabilitation Network

• Gain an understanding of the current contracts and close out open negotiations

• Create a partnership culture with Payers

• Lead the movement towards risk based contracting

• Cultivate relationships with government and non-government agencies

• Works closely with Revenue Cycle and Patient Accounts/Billing to resolve collection roadblocks

• Other duties as assigned

Qualifications:

• Education: Bachelors degree required. Masters degree preferred.

• Work Experience: 5-10 years of experience in managed care contracting and/or the healthcare industry.

o Proven ability to successfully partner with payers and to collaborate effectively with peers within an organization in order to achieve positive results.

o Significant knowledge of contractual, administrative, health insurance and operational issues related to managed care organizations, physician groups (including physician billing experience), hospitals and health insurance benefit plan design preferred.

o Proven and extensive contracting technical skills; negotiation skills, contract preparation and implementation, financial analysis and rate proposal development, and in depth knowledge of various reimbursement methodologies.

o Experience working in a clinically integrated environment.

o Experience with Risk based contracting.

Job Type: Full-time

Work Location:

• One location

Benefits:

• Health insurance
• Dental insurance
• Vision insurance
• Retirement plan
• Paid time off

Schedule:

• Monday to Friday