What are the responsibilities and job description for the Associate Vice President, Payor Strategy position at Appalachian Regional Healthcare, Inc.?
Overview
Develop and manage a portfolio of payor contracts that optimize organization revenue and margin
Develop and implement the strategic plan for payor negotiations
Negotiate reimbursement rates and payment related terms with both new and existing payors effectively, with a focus
on improving reimbursement rates and terms that maximizes enterprise revenues with local, regional, and national
payors
Establish and maintain positive, appropriate relationship with market payors both locally and regionally
Coordinate financial analysis of payor contract performance and modeling projections based on alternate contract
agreements with payors, adverse trends, etc, and make appropriate recommendations or conclusions
Develop and execute effective communication plans with both internal and external stakeholders related to payor
relationships, negotiations, organizational contractual obligations, and development in the managed care marketplace
Identify and capitalize on value-based reimbursement opportunities that strengthen payer partnerships and patient
volumes.
Responsibilities
Contract Negotiation: Leading negotiations with payors to secure favorable terms and
conditions for the organization inclusive of understanding the financial and operational
impacts of contract terms.
· Relationship Management: Building and maintaining strong relationships with payors to
ensure ongoing collaboration and problem-solving.
· Compliance and Regulatory Adherence: Ensuring all contracts comply with relevant laws
and regulations, and staying updated on changes in healthcare policies.
· Financial Analysis: Analyzing financial data to assess the impact of contracts on the
organization’s revenue and profitability.
· Strategic Planning: Developing and implementing strategies to optimize payor contracts
and improve reimbursement rates.
· Performance Monitoring: Tracking and reporting on the performance of payor contracts, identifying areas for improvement.
Qualifications
Education
Bachelor of Science in Healthcare Administration, Business or similar discipline required; MBA prefered
Minimum Work Experience
· 7 - 10 years previous experience working in a payer and or provider contracting or reimbursement environment. · Minimum 5 years in a leadership capacity.
Required Skills, Knowledge, and Abilities
· Highly developed communication and organizational skills
· Significant knowledge of contractual, administrative, health insurance and operational issues related to managed care organizations, hospitals, physician groups, and health insurance benefit plan designs
· 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
· Experience with Fee for Service, Risk and Value Based Contracts for Commercial, Medicare Advantage, Medicaid, and Exchange products..
