Vice President, Contracting and Payor Relations
Vice President, Contracting and Payor Relations, 100% Remote
We are currently working with a PE backed healthcare organization looking to add a Vice President, Contracting and Payor Relations to their team. This individual oversees a team of credentialing and payor contracting specialists to ensure that credentialing practices meet the needs of patients, facilities, payors, the market, state regulations and NCQA, Medicare/Medicaid, URAC, and/or Joint Commission credentialing standards.
The role is primarily responsible for creating and assisting with the development and implementation of supporting policies and procedures and workflows; handling payor contract management to maximize net operating margins and ensure market competitiveness; managing and monitoring the overall Credentialing Plan; evaluating the effectiveness of processes and procedures to support the plan; ensuring the organization is compliant with various credentialing requirements, as applicable; and maintaining payor rate sheet information and ensuring proper updates are distributed and/or uploaded.
Geography: 100% remote
MAJOR DUTIES AND RESPONSIBILITIES
- Establish and implement strategic goals to align with department and corporate goals and objectives
- Oversee the utilization and continuous improvement of the financial reports and analytics used for contract management
- Serve as the organization’s contact for payor contracting functions
- Support resolution of payor contractual issues pertaining to contract interpretation and coding with payors in conjunction with revenue cycle staff
- Assess payor contracting requirements and standards as they relate to industry/regulatory issues and market implications
- Recommend and implement necessary improvements and revisions to contracting requirements and standards
- Lead the development and testing of a contract pricing model and responsible for all activities related to the modeling of contract proposals that maximize net operating margins and ensure market competitiveness
- Ensure that payor fee schedules are updated on a regular basis and are uploaded/assigned in QDW appropriately
- Negotiate better payor fee schedule rates as the organization gains leverage through growth
- Evaluate and update internal UCRs on a regular basis to ensuring that billing practices are positioned for maximum revenue
- Evaluate charge integrity periodically by performing an analysis of charges and reimbursement for common procedures
- Manage and monitor the overall credentialing plan, operations, and needs for compliance. Make any necessary changes.
- Maintain up-to-date credentials for each licensed provider, including verification through primary and secondary sources, records, and relay credentialing information to relevant personal as needed
- Keep accurate records of provider licensure/ certification renewals
- Coordinate provider enrollments in all commercial, state, and federal insurance programs. Correspond with and provide updates to insurances.
- Partner with multi-functional team of business leaders on day-to-day operations
- Maintain knowledge of all state regulatory and accrediting body standards and maintain compliance
- Oversee and/or manage Delegated Agreements and all audit and reporting needs associated with each
- Participate in payor, state, and/or regulatory body interviews/presentations in discussions pertaining to credentialing
- Provide on-going opportunity and challenge for staff development
- Conduct regular meetings with direct reports and credentialing team to ensure that they are well informed of company goals and objectives, to set priorities, and to discuss progress towards goals
- Develop mechanisms for regular on-going feedback on areas of development and/or accomplishments
- Manage contracting and credentialing budget, as well as staffing needs
MINOR DUTIES AND RESPONSIBILITIES
- Participate in other revenue cycle meetings, as necessary
- Perform other duties as required or requested by leadership
- Bachelor’s degree in a relevant subject
- 5-7 years of credentialing experience minimum
- Knowledge of credentialing software preferred
- Working knowledge of NCQA and URAC Credentialing Standards
- Ability to read, analyze and interpret general business periodicals, professional journals, technical procedures, government regulations, standardized instructions, short correspondence, and memos
- Must be able to review and make necessary revisions in credentialing delegation agreements with external payor partners
- 2+ years of supervisory experience
SKILLS AND ABILITIES
- Excellent attention to detail
- Self-directed, organizes and prioritizes work, and manages multiple tasks and assignments
- Ability to work independently within guidelines and company policies
- Manages time well and performs assigned duties with attention detail, accuracy, and follow-through with minimal supervision
- Strong analytical and problem-solving skills with ability to identify trends, define problems, develop solutions, and execute strategies
- Superior skills using Microsoft applications including Outlook, Teams, Word, Excel, and PowerPoint
- Ability to supervise, train, and transfer job knowledge to colleagues
- Strong verbal and written communication skills with ability to provide written communication/education to revenue cycle team members
- Excellent interpersonal skills and experience interacting with clinical and financial personnel in a fast-paced, multi-disciplinary, team environment
- Interacts with confidential information in a professional manner
- Must be able to make independent decisions
Other Open Positions
Vice President of Corporate Development
$200,000 - $250,000
Vice President, Corporate Development This position is with an extremely fast growing and acquisitive, private equity backed, transportation and logistics services group located all over the eastern half of the country. The Vice President, Corporate Development will be resp ....
$85,000 - $125,000
Senior AccountantWe are partnering with a PE backed multi-site healthcare organization looking to add a Senior Accountant to their team. The ideal candidate has a CPA and public accounting experience.The Senior Accountant is responsible for the day-to-day accounting and inte ....
$180,000 - $215,000
Corporate Controller The Corporate Controller position is a hands-on role that is responsible for the accounting affairs of the overall organization and its affiliates. The Corporate Controller is a key member of the Company’s financial team and the process owner for ....
$75,000 - $95,000
Fort Worth, Texas
Senior AccountantWe are partnering with a mid-market PE backed organization looking to add a Senior Accountant to their team. The Senior Accountant is responsible for areas relating to financial reporting and general accounting activities for over 30 regional facilities. Thi ....
$110,000 - $120,000
Fort Worth, Texas
Assistant ControllerWe are partnering with a mid-market PE backed organization looking to add an Assistant Controller to their team. The position is newly created to support growth.Position Summary: Reporting to the Corporate Controller, the Assistant Controller will help d ....
$150,000 - $180,000
Controller We are partnering with a newly purchased PE backed financial service organization in Boston looking to add a Controller to their team. This is the newest portfolio company for the PE firm and they are prepping for exponential growth. The Controller reports direct ....
Accounts Payable Lead
$0 - $0
Accounts Payable LeadOur Client, a national consulting firm, is currently experiencing explosive growth and looking to add an Accounts Payable Lead to their team. In this role, along with the Accounts Payable Manager, you will be responsible for full-cycle Accounts Payable ....
Accounts Payable Associate
$0 - $0
Accounts Payable AssociateOur client is presently in search of an Accounts Payable Associate to join the firm!As an AP Associate, you will work with the accounting team and be responsible for completing payments and controlling expenses by receiving, processing, verifying, a ....
Vice President, Contracting and Payor Relations
$170,000 - $210,000
Vice President, Contracting and Payor Relations, 100% RemoteWe are currently working with a PE backed healthcare organization looking to add a Vice President, Contracting and Payor Relations to their team. This individual oversees a team of credentialing and payor contractin ....
$90,000 - $110,000
Oklahoma City, Oklahoma
Senior Accountant, RemoteWe are partnering with a Private Equity backed distribution organization looking to add a Senior Accountant to their newly purchased entity. The Senior Accountant will be responsible but not limited to all aspects of accounting duties within our orga ....