VP Payer Strategy

Hours:

Shift Start Time:

8 AM

Shift End Time:

4:30 PM

AWS Hours Requirement:

8/40 - 8 Hour Shift

Additional Shift Information:

Weekend Requirements:

Not Specified

On-Call Required:

No

Hourly Pay Range (Minimum - Midpoint - Maximum):

$163.030 - $210.361 - $257.692

 

The stated pay scale reflects the range that Sharp reasonably expects to pay for this position.  The actual pay rate and pay grade for this position will be dependent on a variety of factors, including an applicant’s years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other requirements for the position, and employer business practices. 

 

What You Will Do
Develop strategic direction, negotiate and manage all non-government contracts and managed Medicare and Medi-cal contracts, and all ancillary and JV contracts where applicable, to maximize overall reimbursement for the entire integrated healthcare system. Communicate contractual terms to ensure smooth administration. Provide systemwide strategy and support through industry analysis, contract analysis, consultation in new program development, contract reimbursement modeling for the annual budgeting process, and development and management of affiliated medical group projects as a result of legislation, regulated or health plan directed. Incorporate managed care contracting priorities with organizational strategic direction and initiatives. Assist in project coordination with system support departments – Marketing, Business Development, Managed Care Operations and Finance. Responsible for operational support system to respond to contract informational needs and monitor facility and physician issues regarding contracting priorities. Provide operational support to internal and external customers and main contact for contracted payors. Actively participate in industry trade associations that support both facility and Medical Group divisions. Actively participate in legislative affairs to provide guidance related to the California' new enacted Office of Healthcare Affordability. Identify and represent Sharp's positions to payers to capture additional revenue for unfunded mandates, expansions to coverage and new technologies not contemplated during the negotiation of capitated arrangements. Develop, in coordination with applicable stakeholders, the specific contract strategy for individual payors as well as overall payor strategy, contract renegotiation analysis in accordance with Sharp's messenger model of contracting and operational requisites; create a strategic vision that aligns with the organization's goals and objectives. Prepare systemwide operational and financial analysis for new contract consideration and existing contract renegotiations. Foster payer relationships between contracting cycles to develop ongoing, positive connections with health plans, large employer groups/trusts, broker groups and other collaboration groups like APG, HICE and other industry trade associations, building credibility and trust. Prepare acute care facility non-government contract financial performance reporting through monthly FARM reports and physician group payor specific analysis. Manage contract performance and compliance through an integrated effort with the Business Services Department and Managed Care Finance through contract monitoring and information distribution. Work in conjunction with staff in consultative role on specific contract related issues. Advise executive leadership team on emerging trends and methodologies in contracting and payer relations; support Chief Financial Officers, Presidents of the Medical Groups and Medical Directors, and CEOs of each entity on contract related topics. Responsible for the sub-contracted provider contract and letters of agreement negotiations, communication of contractual terms and ongoing relationships for Sharp HealthCare hospitals Sharp Rees-Stealy Medical Group, Sharp Community Medical Group, and ambulatory surgery centers. Manage and foster growth of personnel in the Contracts and Managed Care Finance departments.
Required Qualifications

• 10 Or More Years experience in health care at a position in contracting.

Preferred Qualifications

• Master's Degree

Other Qualification Requirements

• Bachelor's Degree in accounting, finance, business administration or health care administration; or 4 years of related health care experience may substitute for degree. - Required

Essential Functions

• QUALITY / CUSTOMER SERVICE
  Maintains systemwide service orientation to representatives of Sharp HealthCare entities, including hospitals and medical groups, through consistent assessment of needs and timely response to requests. Average customer overall satisfaction indicator, as measured through annual survey, to equal or exceed ‘satisfied’ scale measure.
  Develop and maintain relationships with payer executives in support of the Sharp HealthCare mission, values and philosophy, and ensure timely response to contractual issues and contract compliance problems. Collaborate with key individuals to align contracting strategies with organizational mission and financial objectives.
  Evaluate contract language and provide financial and statistical analysis, with the goal of development like kind reporting across the system, for contract analysis and budget development. Maximize reimbursement and minimize financial risk and legal issues.
  Negotiate contracts in accordance with each entities desired reimbursement goals.
• STRATEGIC LEADERSHIP
  Develop and implement payer strategy, building and maintaining payer relationships, and negotiate contracts to further drive a clear and effective reimbursement approach. Develop a direction and formulate long-term, sustainable goals for both commercial and government payers.
  Develop and maintain communication links throughout the system to identify payer issues and the development of action items for resolution. In addition, communicate current contract information, address contract issues and work with both hospital and medical group executive leadership to identify system-wide contracting objectives. Satisfaction indicator to be measured to equal or exceed ‘satisfied’.
  Effectively participates with and/or provides support in the design, review, development and implementation of new programs. Efficiently allocate resources to meet or exceed time expectations for these projects at least 85% to 95% of the time.
  Works in conjunction with staff to design and implement contract reimbursement modeling and analysis used in contract renegotiation and to ensure correct reimbursements. Successfully completes analysis and submits initial proposal within renegotiation time frames 80% to 85% of the time.
  Stay informed on emerging payer trends, reimbursement methodologies, regulatory issues, plan benefits, payer activity, and market competition. Utilize this information in concert with current payer mix and future market projections to develop and maintain growth strategies. Ensure that contracts optimize pricing and align hospital and physician incentives.
• SYSTEMS INTEGRATION
  Assure appropriate parties are informed of contractual modifications and new or terminated contracts. Work with Managed Care Operations, hospital and medical group organizations divisions to ensure systems are accurate for claim pricing and claims payment. Work towards system initiates to improve efficiency through integration.
  Serve as an executive liaison, and maintain effective operational linkages to Business Development, Finance, and Revenue Cycle teams.
• EMPLOYMENT MANAGEMENT
  Recruit, lead and develop personnel involved in payer strategy, payer contracting and Managed Care finance. Hold quarterly ‘all staff’ meetings with all departments, as well as monthly Contracts department staff meetings to provided information on upcoming projects, review status reports on current projects, share contracting priorities and objectives and address annual Employees Engagement Survey. Practices safe working habits.

Knowledge, Skills, and Abilities

• Demonstrated analytical ability in a health related or contract negotiation environment.
• Excellent skills in verbal and written communication; excellent knowledge of Managed Care, Health Care Finance, Manage Care Contracts and Patient Accounting; experience in PC computer utilization for work processing, spreadsheet analysis and managerial skills.
• Additionally, the ability to develop and maintain good working relationships with payor executives is critical and prior experience is required.

Sharp HealthCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability or any other protected class