VP OF PAYOR RELATIONS

Job Description

New Season

Employee Name: Reports to: Sr. Vice President Revenue Mgmt Job Code: 575

Department: Payor Relations FLSA: Exempt Direct Reports: 6+

Job Summary:

This position is responsible for maintaining contractual relationships with payers and health plans. Facilitates payer contracting activities, including contract review, negotiation of terms, strategic positioning, provider enrollment, dispute resolution and growth opportunities. Responsible for the maintenance of managed care plan operating policies and systems; developing effective relationships with payers and providers related to those managed care plans; coordinating the analysis, reporting and negotiation of payer contracts. This position also oversees the charge data master (CDM) and practice management database where provider, location and group information is stored for business purposes.

Essential Functions:

➢ Establishes and maintains relationships with third party payors, educating them on the dynamics of Medication Assisted Treatment (MAT).

➢ Manages contract renewals, revalidations, and renegotiations as required; creates and maintains a contract tracking database to ensure contracts are reviewed and renewed on a timely basis.

➢ Responsible as primary lead for organization in communications to payers for contract negotiations

➢ Monitors, analyzes and reports on the state of the payer industry via report cards and other assessments.

➢ Assists with the negotiation and monitoring of contract performance of value-based contracts with payers, including the success of meeting financial and quality targets.

➢ Identifies opportunities to serve members in a particular market due to a health plan presence where a contractual opportunity exists.

➢ Manages contract enrollment and works with Credentialing team to manage credentialing and recredentialing activities.

➢ Oversees the establishment of contractual relationships and announces the rollout of a new health plan as well as reporting interim activity.

➢ Works with the Audit & Analyst Team to assess and respond to payment proposals and to develop modeling analysis tools.

➢ Partners with Revenue Cycle Operations and other leadership disciplines to establish guidelines, policies and protocols regarding payor/provider interactions.

➢ Collaborates with the Senior Vice President of Revenue Management in the resolution of escalated issues with payors.

➢ Develop indicators for monitoring and evaluating quality of work and meeting turnaround time standards.

➢ Establishes work directions, resolves problems, and sets performance expectations and deadlines to ensure timely completion of all department deliverables.

➢ Participates in / manages special projects as requested/required.

➢ Encourages team members to expand their knowledge base by learning new areas of Revenue Management and also encourages willingness to perform duties outside of their day-to-day responsibilities.

➢ Keep lines of communication open with the Operations team to ensure individualized goals are met.

➢ Maintains confidentiality and safeguards the operations of business.

➢ Adheres to the service policy and principles of CMG/New Seasons.

➢ Other duties are assigned.

Supervisory Responsibilities:

(This position will supervise exempt and non-exempt staff in support roles performing duties described in “Essential Functions”.)

This position will supervise multiple positions including but not limited to the Director Payer Relations, Contract Administrator, RCM Analysts.

Essential Qualifications:

(To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the competencies (minimum knowledge, skill, and ability) required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions).

Education/Licensure/Certification: This position requires a Bachelor’s Degree in business or related field required.

Required Knowledge: The ideal candidate will have strong oral and written communication and relationship building skills. Also, knowledge of the contracting process; knowledge of major U.S managed care and non-managed care health insurers.

Experience Required: The ideal candidate will have a minimum of 5 years of third-party healthcare insurance contracting experience, including contract renegotiation. Experience with behavioral healthcare organization preferred. Thorough knowledge of the experience with healthcare regulatory environment, and strong industry relationships with managed care/non-managed care third party payors.

Skill and Ability: The ideal candidate will have the ability to work collaboratively with colleagues. Strong organizational skills with a keen ability to prioritize and multitask. Ability to adhere and meet deadlines. Good communicator. Strong administrative and management skills. Ability to raise issues proactively in a timely manner. Strong presentation skills.

Physical Demands/Work Environment:

(The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.)

Finger Dexterity: Use primarily for writing, operating calculators, telephone, keyboard and other office equipment.

Talking: To convey detailed or important instructions to employees, patients and applicants.

Hearing: Ability to hear normal conversations and receive ordinary information.

Vision: Average, ordinary, visual acuity necessary to observe patients and work on the computer. Clear vision at 20 inches or less and distant vision at 20 feet or more.

Physical Strength: Sedentary work; sitting most of the time. Exerts up to 10 pounds of force occasionally.

Working Conditions:

(The working conditions described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.)

➢ Ability to operate in an open work area with moderate everyday noise.

Core Competencies:

➢ Negotiating

➢ Organization

➢ Approachability

➢ Change management

➢ Communication (oral & written)

➢ Ethics/Values/Integrity

➢ Influencing/Persuading

➢ Listening

➢ Problem Solving

➢ Strategic Planning/Thinking

Mental Activities:

(The mental activities described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.)

Reasoning Ability: Ability to resolve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram or schedule form. Ability to maintain confidentiality.

Mathematics Ability: Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumferences and volume.

Language Ability: Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, and governmental regulations. Ability to write reports and business correspondence. Ability to effectively present information and respond to questions from groups of managers, employees, patients and the general public.

New Season

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Vice President of Payor Relations