Vice President of Payor Relations

3 weeks ago

Nashville, Tennessee, United States Newport Healthcare Full time

About Us

Newport Healthcare is a leading provider of behavioral healthcare services, dedicated to delivering high-quality care to young people and their families. Our team of experts is committed to transforming lives through evidence-based treatment, and we're seeking a skilled professional to join our leadership team.

Our Mission

We're passionate about empowering individuals and families to achieve their full potential, and we're committed to providing compassionate care that's based on authentic connection, mutual respect, and unconditional love. Our goal is to make a positive impact in the lives of those we serve, and we're looking for a talented individual to help us achieve this mission.

Responsibilities

  • Lead our payor relationships and managed care contracting activity across the enterprise, building strong relationships with payors and executing on contract negotiations and implementation.
  • Develop and implement innovative contracting models that may include value-based and pay-for-performance reimbursement models.
  • Oversee the strategic direction of Newport Healthcare's managed care contracts and their implementation, ensuring that our organization is well-positioned to meet the needs of our payors and stakeholders.
  • Monitor contract performance regarding financial performance, payment integrity, and compliance with contract terms and key performance indicators.
  • Serve as a liaison between the company and the payors with respect to revenue cycle management issues.
  • Monitor payor activity with respect to network development, product strategies, payment policies, and other relevant market intelligence.
  • Oversee payor relationships with a focus on promoting proactive, professional, and collaborative relationships.
  • Recommend contract management tools to enhance and streamline the contracting process.
  • Work collaboratively with various Newport Healthcare operating units, and support areas such as clinical operations, revenue cycle, and utilization review areas to improve functions across departments and with payors.
  • Assist in developing creative pricing and contract structures, including value-based care arrangements, to ensure value to the payor and profitability for the company.
  • Maintain familiarity of State and Federal regulations, laws, and legislative agendas regarding health insurance, managed care, mental health parity, and value-based care.
  • Prepare performance, statistical, and other operational reports.
  • Manage facility and provider credentialing.
  • Supervise, oversee, and develop direct reports (if any/as applicable) in accordance with their job descriptions, all Company requirements, and the dictates of personnel management best practices.
  • Practice and adhere to Newport Healthcare's mission and values statements and code of conduct and attend all required ethics and compliance training and retraining.
  • Perform other duties as assigned.

Qualifications

  • Demonstrates professional behavior reflective of Newport Healthcare's Mission Statement, Philosophy, and Values.
  • Customer Focus. Actively demonstrates a dedication to meeting the expectations and requirements from internal and external customers; gets firsthand information and uses it for improvements in products and services; always acts with the customer or patient in mind.
  • Able to understand and accept changes in the work environment; changes approach or method to best fit the situation; able to deal with frequent change, delays, or unexpected events.
  • Demonstrates ability to clearly and succinctly communicate both verbally and in writing; can get messages across that have the desired effect.
  • Commits to doing the best job possible; Follows instructions, responds to management direction; Keeps commitments; Meets attendance and punctuality guidelines; Responds to requests for service and assistance; Takes responsibility for own actions.
  • Must be able to accurately produce work which requires continual attention to detail.
  • Fast-Paced Environment. Must be able to work in a fast-paced environment with demonstrated ability to juggle multiple competing tasks and demands.
  • Industry Knowledge. Demonstrates a working knowledge of current and possible future policies, practices, trends, and developments affecting the industry; knows the competition.
  • Interpersonal Savvy. Must be able to relate well to all kinds of people both inside and outside the organization; build appropriate rapport; build constructive and effective relationships; use diplomacy and tact; can diffuse even high-tension situations comfortably.
  • Can negotiate skillfully in tough situations; can settle differences; can win concessions without damaging relationships.
  • Presentation Skills. Must be effective in a variety of formal presentation settings: one-on-one, small, and large groups, with peers and direct reports.

Education and Experience Requirements

  • Bachelor's degree in business or a related field required; master's degree preferred.
  • 10+ years of full-time professional experience in managed care contracting required.
  • 5+ years in a leadership role required.
  • Experience successfully leading payor relations for a multi-state healthcare services organization required (behavioral health preferred).
  • Demonstrated knowledge and ability to analyze payor contracts, provider manuals, reimbursement methodologies, and rates.
  • Significant knowledge of contractual, administrative, health insurance, and operational issues related to managed care organizations, healthcare providers, and health insurance benefit plan designs.
  • Proficiency with Microsoft Office, Google Suite, CRM, and video conferencing technologies.
  • Exceptional interpersonal, relationship-building, and listening skills, with a natural, consultative style.
  • Expert in advising, presenting to, and persuading senior leaders.
  • A winning mentality.

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