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Director of Payor Strategy
5 months ago
Company Intro:
At **American Vision Partners (AVP)**, we partner with the most respected ophthalmology practices in the country and integrate best-in-class management systems, operational infrastructure, and advanced technology to provide the highest quality patient care possible. Our practices include Barnet Dulaney Perkins Eye Center, Southwestern Eye Center, Retinal Consultants of Arizona, M&M Eye Institute, Abrams Eye Institute, Southwest Eye Institute, Aiello Eye Institute, Moretsky Cassidy Vision Correction, Wellish Vision Institute, West Texas Eye Associates and Vantage Eye Center. We are focused on building the nation’s largest and most comprehensive eye care practices and currently operate more than 100 eye care centers in Arizona, New Mexico, Nevada, California and Texas - including 25 ambulatory surgical centers.
At AVP we value teamwork, providing exceptional experiences, continuous improvement, financial strength, and hard work. We are committed to providing best-in-class patient care, pioneering research and technology, and most importantly, rewarding and recognizing our employees
Overview:
**Responsibilities**:
- Analyzes, evaluates and negotiates new and existing payor contracts.
- Drive payor reimbursement and revenue growth to maximize value for organization.
- Develop and create relationships with IPA, physician groups and other healthcare providers.
- Identifies provider targets for network development initiatives as well as maintaining adequate network coverage of existing specialties.
- Develop and maintain strategy for narrow network opportunities.
- Develops and implements reimbursement models that maximize reimbursement (including incentive / risk & reward models as necessary), through collaboration with various departments, including clinical and finance departments.
- Maintain thorough understanding of AVP business strategy and day to day operations.
- Establish, manage, and maintain positive, strategic relationships with payors, employers, product distribution channels and providers as applicable the region.
- Partner with revenue cycle management to ensure that payors are adequately following their contractual terms, addressing where appropriate and following through to ensure completion.
- Works closely with analytics teams in developing/establishing provider reimbursement models and parameters.
- Ensures alignment of payor programs with the company's strategic business initiatives.
- Stays current with managed care and regulatory issues in relation to health benefits, payor activity, contracting and reimbursement methodologies, products and delivery channels including health insurance exchanges, market competition, etc.
- Collaborates with clinical team to influence and change adverse payor policies.
- Monitor, assess, and measure the financial impact on the organization of prospective regulatory changes to Federal and State reimbursements.
- Performs other duties as assigned
Qualifications:
- Bachelor's degree in Business Administration, Health Care Administration, Public Health Science or related discipline.
- Minimum five years’ experience in the insurance or healthcare industry, with responsibility for negotiating contracts with healthcare providers and/or health plans.
- Demonstrated experience with proven track record in physician network development, strategic and/or business planning, or payor contracting.
- Excellent verbal, written and presentation skills.
- Excellent PC skills; MS Access, Excel, Decision Support/Contract modeling/Reimbursement software or comparable PC based database skills required.
- Extremely organized and detail oriented with exceptional follow through skills.
- Ability to multi-task in a fast pace environment; can adapt quickly to change; have strong negotiation skills.
- Ability to organize workload, manage multiple projects, and maintain confidentiality of all work information
- Ability to establish and maintain effective working relationship with team members, clinic staff, payors and providers.
Benefits & Perks:
Your health, happiness and your future matters At AVP, we offer everything medical and dental insurance, significant eye care discounts, child care assistance, pet insurance, continuing education funds, 401(k), paid holidays plus PTO, Sick Time, opportunity for growth, and much more
