Apply

Vice President - Payor Relations

Job Overview
Job Order:JO00019427
Date Posted:Jul 23
Salary:
Category:1 - Accounting & Finance
Metro Area:

Our Client is looking for a Vice President of Payor Relations. The position is located in the Metro Detroit area.

The Vice President, Payer Relations will report to the Chief Financial Officer and will be responsible for leading all aspects of the payer contracting strategy, including:

  • Managing and expanding contracted relationships with third-party payers at desired reimbursement rates and payment terms.
  • Developing, maintaining, and executing a quarterly strategic and tactical plan focused on expanding contracts with existing in-network payers and expanding in-network managed care footprint with all major Dental Management Organizations, PPOs and government payers.
  • Designing and propagating the “Quality Story”—a combination of clinical outcomes, patient experience and cost, quality and safety data—to position the Company favorably with payers and large, self-insured employers within the local markets served.
  • Translating deep knowledge of physician/professional service compensation, dental fee schedules, capitation agreements and other forms of reimbursement into a cohesive payer strategy.
  • Directing the design of large data models to forecast and monitor payer rates by code and a track record of success working in an environment of collaboration, transparency, mutual respect, and passion for excellence and innovation.
  • Spearheading high-stakes negotiations with major payers and self-insured employers.

RESPONSIBILITIES

  • Build a payer analytics capability that enables the Company to benchmark utilization and reimbursement levels across its office network.
  • Effectively manage contract renewals and re-negotiations to ensure the Company balances patient access with reimbursement levels appropriate for the level of clinical quality that providers deliver.
  • Represent the interests of a multi-state Dental Service Organization (DSO)
  • Foster and manage professional relationships with payer contracting managers and executives, as well as internal leaders;
  • Lead payer contracting negotiations
  • Build and maintain lasting payer relationships in the dental industry
  • Work with and manage outside consultants and contracted third-parties
  • Collaborate with corporate leadership to determine contracting strategy and expansion opportunities to execute the company’s payer relationship strategy
  • Thoroughly analyze and review rates and utilization in order to drive mutually beneficial outcomes for dental patients and providers
  • Analyze fee schedules by specialty and code relative to historical company utilization and industry comps
  • Negotiate contract language and facilitate review from in-house legal counsel
  • Oversee contract monitoring, reporting, anniversary dates, and notification requirements to ensure annual rates are implemented correctly and on-time
  • Develop and maintain appropriate policies, procedures, and controls for dental contracts and payer contracting activity
  • Coordinate and manage analytical resources to quantify rate impacts during negotiations and monitor ongoing utilization and expected fee changes
  • Remain abreast of local, regional, and national developments pertaining to dental industry payer rates and methodologies and incorporate any changes into broader payer strategy

EDUCATION & EXPERIENCE

  • 7 to 10 years of payer relations experience for an integrated health network; preferably experience leading payer relations with a Dental Service Organization (DSO);
  • Undergraduate degree in business or a related field is a must
  • MBA or a similar advanced degree preferred.
  • While relocation is not necessary, the candidate must travel as needed to engage with the Leadership Team and key player and self-insured employers.

If you are a high performer and would like to work for an equally high performing company and you think the above opportunity is appropriate for you, we invite you to apply to this job and email your resume to kroehrig@venteon.us.com

We treat all resumes with strict confidentiality. We will always contact you first before submitting your resume to our client(s) for review. If you do not receive correspondence, you are not a fit for this position.

At Venteon, our talent acquisition team is proud to provide our clients with the most qualified Accounting & Finance, Engineering and IT talent in the industry today.

#VTN1