VP of Payer Contracting

Millennium Physician Group; Fort Myers (FL); On-site; USD 90,000 - 150,000; Full time

Job summary

Join a forward-thinking healthcare organization as a Full-Time VP of Payer Contracting. This pivotal role offers the opportunity to shape payer relationships and develop innovative contracting strategies that enhance patient care. You will lead negotiations with various health plans, ensuring that contracts align with organizational goals while fostering a collaborative environment. With a focus on value-based care and financial performance, you will work closely with executive leadership to optimize reimbursement models and drive strategic initiatives. If you're ready to make a significant impact in a dynamic and growing organization, this is the perfect opportunity for you.

Benefits

401(k) with match

3 weeks of PTO

Opportunities for growth

Team atmosphere

Qualifications

• 10+ years in contract negotiations with healthcare focus.
• Strong leadership skills with experience in team building.

Responsibilities

• Lead payer negotiations and develop innovative reimbursement structures.
• Manage contracting for value-based and fee-for-service initiatives.

Skills

Contract Negotiation

Healthcare Economics

Managed Care

Leadership

Relationship Building

Value-Based Care

Regulatory Knowledge

Education

Bachelor's in Health Care Administration

MBA or MHA

Job description

Millennium Physician Group is seeking to hire a Full-Time VP of Payer Contracting to join our team. We are looking for a candidate who is positive, energetic, well-organized, can multi-task, and think outside of the box. We want someone who supports our top initiative of ensuring an excellent patient experience!

This position earns competitive compensation plus a full benefits package including 401(k) with match and 3 weeks of PTO! We also offer opportunities for growth, as well as a great team atmosphere that empowers you to seek better ways to deliver service and take ownership of outcomes in providing quality service and support.

Reporting to the Chief Value Based Officer, the VP of Payer Contracting will lead the development and execution of a comprehensive payer contracting strategy across all payers and all lines of business working with executive leadership to assure that Millennium Physician Group's payer contracts support the achievement of the overall organizational financial and operating goals.

They will manage the responsibility of contracting with all payers, including contracts for value-based arrangements (VBA) and traditional fee-for-service (FFS) contracts, and coordinating the contract terms with the applicable departments for implementation of all contracts. This role will help in identifying and prioritizing payer relationships, assessing risk profiles, and negotiating optimal risk-based contracts with health plans, including contract review, negotiation of terms, and strategic positioning. They will be responsible for negotiating contracts for related entities such as Millennium Home Health and the ambulatory surgery center(s).

This individual, in conjunction with the finance and value-based finance areas, will lead the development of pricing strategies, reimbursement terms, and contract modeling to offer in-depth understanding of managed care contract policies and value for contracts through pre- and post-implementation. Additionally, they will lead in the development of value-based care strategies and initiatives to assess value-based payment models, evolving healthcare payment reforms, and payment methodologies. They will collaborate across the organization to develop and implement value propositions and own the responsibility to identify and prioritize the strategic initiatives related to healthcare economics and contract compliance, ensuring those are delivered.

They will also coordinate and build consensus with key stakeholders for developing Millennium's analytics and reporting functions, specifically to support payer contract evaluation and negotiations, reimbursement projections pricing strategy, and contract performance and optimization, along with contract compliance across the entire MPG payer portfolio.

Given Millennium's growth trajectory, contracting activities will accelerate substantially in volume, financial impact, and complexity so this role is ideal for a candidate who thrives in a complex, fast-paced environment.

Position Responsibilities: (and other duties as assigned)

• Responsible for both leading and supporting payer negotiations with an emphasis on building strong, collaborative payer relationships that support innovative reimbursement structures to advance the best interest of high quality, affordable patient care.
• Provide strategic leadership regarding value-based and fee-for-service contracting initiatives.
• Lead all contracting functions of the organization, as well as continued development of a portfolio to support the growth of the organization.
• Lead the negotiation and oversight of provider contracting in conjunction with Millennium Home Health and contracting for the ambulatory surgery center(s) along with any newly developed ambulatory services.
• Partner with Executive leadership to devise payer strategies that align with organizational goals including market access and financial strength, including evaluation and initiation of new MPG contract opportunities, business models and payers' relationships.
• Advance Millennium's fee-for-service payment strategy through optimization of existing contracts and development of new reimbursement models.
• Advise the Executive leadership team on emerging trends and methodologies in managed care contracting, payor relations and legal issues.
• Apply current knowledge and understanding of regulations, industry trends, current best practices, new developments, and applicable laws to ensure operational and financial effectiveness.
• Develop, implement, and maintain production and quality standards for the payer contracting department.
• Work closely with health analytics team to define performance outcome and tracking.
• Form strong, collaborative, working relationships across multiple payer organizations to advance innovative reimbursement arrangements that support advancement of quality and affordability of care.
• Develop and maintain contract summaries including performance targets and measures of matrix, timelines, contract requirements and deadlines.
• Monitor and manage payer compliance issues including rosters, assignment, reports, delivery dates, fees, audits.
• Monitor and analyze changes in payer fee-for-service programs and policies that may affect contract performance and initiate negotiations as warranted.
• Ensure coordination of any credentialing or request for information requirements for new FFS or VBA initiatives.
• Participate in and report to Executive leadership groups; provide support for these meetings and assist with FFS and VBA contract material preparation and presentation.
• Create strategic alliances with internal and external groups to maximize member and payer relations and all payer contract performance.

Position Qualifications:

• Bachelor's degree in Health Care Administration, Business, Economics, or a related field is required. MBA, MHA preferred.
• Ten or more (10+) years of experience in contract negotiations, preferably within provider and/or payer settings, with at least five or more (5+) years of experience or knowledge of managed care, healthcare economics, managed care pricing, product/network development or management.
• A minimum of five (5) years successful leadership/management experience. Leadership skills inclusive of ability to build high-performing teams, and to provide coaching and mentorship of future talent.
• Demonstrated track record of building strong working relationships across operational leaders and potential payer partners.
• Strong understanding of Medicare reimbursement, Medicare Advantage health plan economics, and value-based and contracting models, including legal and regulatory considerations.

• Demonstrated success negotiating value-based contracts with various health plans, or for various health plans, using a diverse range of techniques.
• Experience driving discipline, consistency, and execution of standardized initiatives and best practices. Ability to facilitate mechanisms to utilize pilots, measure results, and ultimately identify best practices to be used across the healthcare system.

ABOUT MILLENNIUM PHYSICIAN GROUP

Formed in 2008, Millennium Physician Group has grown into one of the largest comprehensive primary care practices with more than 400 health care providers located throughout Florida. With corporate headquarters in Fort Myers, Florida, Millennium Physician Group consists of primary care offices, Imaging Centers, Lab Services, and Wellness Programs. You can also find various programs, such as weight management and smoking cessation, led by Millennium Physician Group doctors.

Millennium Physician Group is proud to be an Equal Opportunity Employer and a Drug-Free Workplace. Additionally, Millennium is proud to join the nearly 3,000 health system and physician groups who have gone completely Tobacco Free.

ARE YOU READY TO JOIN OUR TEAM? If you feel that you would be right for this position, please click the link to apply today. We look forward to meeting you!