VP of Contracting and Government Affairs
The VP of Contracting and Government Affairs is responsible for identifying, developing, and managing regional health plan relationships across the United States. This position is responsible for managing payor contract terms and provisions to ensure compliance for business operations and ensure operational processes comply with contractual obligations. Work collaboratively with all Revenue Cycle functional areas to meet stated goals and objectives for CMS. This individual will be responsible for partnering with regional health Plans on programs that are mutually beneficial for both organizations. This individual will also keep abreast of all federal regulatory changes that affect the payment environment for our services.
PRIMARY JOB RESPONSIBILITES
- Develop and provide oversight to regional payer-contracting programs designed to improve operational performance of the agreements including facilitation of meetings between payers and internal Company’s departments
- In collaboration with our leadership team, legal resources and compliance department, oversee regional health plan agreements to recommend and ensure successful initial and or renegotiation of contracts and execution of contracts, outlining defined se4rvices rendered, both new and existing, billing codes (added, deleted or changed), service areas (geographical), and any exclusions that need to be present in the contractual agreements;
- Analyze insurance payment trends by carrier and in aggregate to make recommendations for contract and fee negotiation
- Collaborate with the CEO to ensure optimal contract language is obtained and in accordance with state and federal guidelines
- Partner with operations, prior authorization coordinators, business office, and other internal departments as necessary to communicate payer updates and provide assistance to resolve operational issues with payers
- Maintain a thorough knowledge of reimbursement methodologies, contractual terms, billing, and other operational factors needed for contracting and contract implementation
- Serve as a liaison for internal departments and payer contacts to address and settle escalated issues in accordance with contractual guidelines
- Facilitate payer meetings, in-services, education, and training to address and resolve issues regarding health plan protocols, procedures, processes and overall effectiveness of the contractual relationship
- Act as a resource to understand the payer and reimbursement relationships that affect our revenue cycle business performance
- Lead contract negotiations and ensures all contracts are reviewed and audited for accuracy prior and upon execution.
Education, Certification and Experience Requirements
- Bachelor’s Degree in Business, Health Care or Science, knowledge in accounting, business administration or related field from an accredited college or university or the international equivalent required.
- 5+ years of internal health plan experience, preferably in a carrier setting
- Fluency in contract negotiations and proficient in relationships at the C-level insurance partnerships
- Knowledge of and Understanding of rules, requirements, and functions of Medicare and Medicaid
- Knowledge of and Understanding of rules, requirements, and functions of TPL entities to include commercial plans, VA/Tri-care, Correctional Health and other TPL sources
- Keen understanding of health plan operations including reimbursement in the outpatient clinical space
- Strong understanding of compliance requirements for Healthcare Revenue Cycle Management
- Revenue cycle management operational experience strongly desired
- Prior experience with various types of health plans strongly desired
- Willingness to travel, if and as required (approximately 70% travel)
- Ability to work effectively from a home office or corporate environment, depending on the current requirements
- Must have a valid Driver License
- Ability to engage in a consultative process that overcomes objections and indifferences while connecting client needs with the company’s capabilities
- Ability to work independently, communicate proactively, manage multiple projects, and prioritize daily tasks while managing critical deadlines
- Ability to develop and utilize cross-functional relationships to facilitate the accomplishment of work goals and objectives
- Advanced presentation skills and excellent overall oral and written communication skills
- Strong analytical and interpersonal skills within all levels of the organization
- Ability to navigate within automated systems and proficiency in Outlook, Word, and Excel
Tools and Equipment Requirements
- The ability to use a phone, computer, printer, and copier is required.
- Proficiency required in Microsoft Office (preferably 365) suite
- Microsoft Access and Understanding of Database and SQL infrastructure strongly recommended
- The ability to use the internet and various web browser software is required.
Physical Working Conditions and Office Setting Description
- Requires sitting and standing associated with a normal office environment.
- Manual dexterity using a calculator and computer keyboard.
- Requires prolonged sitting, standing, frequent bending, stooping, or stretching.
- Some lifting may be required.
- Frequent and prolonged typing and frequent and prolonged operation of computer, keyboard, and telephones required.
- Requires occasional use of fax machines, telephones, copiers, and other office equipment.
- Employee must regularly lift and/or move up to 10 pounds, frequently lift and/or move up to 25 pounds and occasionally lift and/or move up to 50 pounds.
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.
We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, national origin, sex, disability status, sexual orientation, gender identity, age, protected veteran status or any other characteristic protected by law. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.
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We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.
Job posted: 2020-06-15