VP, Operations-Payor Partnerships

Summit Health; United States; Remote; USD 220,000 - 281,000; Full time

Job summary

Join a forward-thinking company as the Vice President of Operations, Payor Partnerships, where you will lead strategic initiatives to enhance healthcare delivery. This role involves overseeing operational excellence in payor partnerships, managing contract structures, and fostering relationships with national payor partners. You will collaborate with finance and operational leaders to ensure alignment with performance targets and budgets. If you are a strategic healthcare leader passionate about innovation, this is your opportunity to make a significant impact on the future of healthcare across the nation.

Benefits

Health Insurance

Dental Insurance

Life Insurance

401k Plan

Disability Coverage

Vision Coverage

Qualifications

• 20+ years in progressive roles required.
• Demonstrated analytical, project management, and leadership skills.
• Understanding of Medicare Advantage bid process.

Responsibilities

• Drive operational excellence and strategic growth in healthcare services.
• Oversee payor contracts and manage relationships with national payor partners.
• Lead implementation of audit processes for operational areas.

Skills

Strategic Leadership

Operational Excellence

Analytical Skills

Project Management

Healthcare Reimbursement Knowledge

Regulatory Compliance

Data Analytics

Education

Bachelor's Degree in Business

Tools

Excel

PowerPoint

Word

Job description

About Our Company

We’re a physician-led, patient-centric network committed to simplifying health care and bringing a more connected kind of care.

Our primary, multispecialty, and urgent care providers serve millions of patients in traditional practices, patients' homes and virtually through VillageMD and our operating companies Village Medical, Village Medical at Home, Summit Health, CityMD, and Starling Physicians .

When you join our team, you become part of a compassionate community of people who work hard every day to make health care better for all.We are innovating value-based care and leveraging integrated applications, population insights and staffing expertise to ensure all patients have access to high-quality, connected care services that provide better outcomes at a reduced total cost of care.

Please Note: We will only contact candidates regarding your applications from one of the following domains: @summithealth.com, @citymd.net, @villagemd.com, @villagemedical.com, @westmedgroup.com, @starlingphysicians.com, or @bmctotalcare.com.

Job Description

Village Medical is seeking a dynamic and experienced Vice President of Operations, Payor Partnerships to join our Enterprise team. The VP of Operations will play a critical role in driving operational excellence, strategic growth, and the delivery of high-quality, cost-effective healthcare services.

This role is responsible for the development and implementation of both value-based care (VBC) and fee-for-service (FFS) agreements that align with the VillageMD business model and support profitable growth. The individual will lead a team responsible for operational implementation and oversight of payor contracts, including overseeing post-execution payer contract operational activities, such as facilitating contract and rate load, managing contract document retention, and generating high-level reporting on contract status and key terms. Additionally, in partnership with Revenue Cycle Management, the individual will have oversight of credentialing process and related processes with payors. Finally, the individual will play a critical role in managing and strengthening relationships with national payor partners to ensure continued collaboration and alignment with VillageMD’s strategic goals.

In collaboration with the VillageMD Finance organization and operational leaders throughout the Enterprise, the individual will ensure partnership alignment with performance targets, annual budgets, and financial improvement strategies.

Key Responsibilities:

• Operate effectively in a highly integrated, matrix environment where s/he will regularly consult with colleagues and recommend plans of actions on a broad range of strategic and tactical initiatives.

• Apply current knowledge and understanding of regulations, industry trends, current best practices, new developments, and applicable laws to ensure operational and financial effectiveness. Partners to ensure regulatory compliance for all areas of responsibility

• Develop, implement, and maintain production and quality standards for the payor contracting department

• Develop and implement the contract structures and reimbursement methods and rates for all professional, institutional, ancillary and vendor providers

• Partner with Business Unit Leadership to design, execute, and manage third party service delivery network

• Work closely with Operations team members to ensure that key provider support processes are optimized

• Form strong, collaborative, working relationships across multiple payor organizations to advance innovative reimbursement arrangements that support advancement of quality and affordability of care

• Leverage data analytics, business insights, and cross-functional collaboration to drive operational and financial optimization.

• Oversee Credentialing process

• Oversee Payor Enrollment process

• Serve as a member of the Credentialing Committee

• S upport Market leaders in oversight of Roster Management processes

• Lead implementation of audit process for key operational areas, such as Credentialing, Payor Enrollment, and Roster Management, and support development of post audit improvement plans.

• Oversee performance monitoring of credentialing and enrollment vendors.

• In partnership with Revenue Cycle Management, support resolution efforts of material payer issues.

• Oversee the implementation of FFS fee schedules in revenue cycle management (RCM) systems.

• Lead the implementation and management of a Contract Management System, ensuring effective reporting and contract tracking. Lead the implementation of new and existing contracts with all internal stakeholders, ensuring smooth execution.

• Provide education and training on payor contracting information, regulatory changes, and contract methodologies to internal teams.

• Maintain and update PADU guidelines and ensure contract provisions align with VillageMD's goals and compliance standards.

• Support the Payor Contracting team with insights on legislative, regulatory, and market developments to optimize the value of payor agreements.

• Lead and manage strategic relationships with specific and identified national payor partners, ensuring alignment with VillageMD’s goals and fostering long-term collaboration.

If you are a strategic healthcare leader with a passion for innovation and excellence, we invite you to join our team and help shape the future of healthcare across our VillageMD markets nationwide.

Skills for success

• Ability to be proactive with strong personal initiative as well as highly organized and detail oriented

• Effectively contributing to building collaborative payor relationships that result in advantageous contract arrangements

• Understanding of medical cost trends that drive gains and losses across risk pools

• Ability to navigate within ambiguity, a service orientation, and a high level of humility are vital for successful assimilation into our highly collaborative, entrepreneurial culture

• Understanding of Medicare Advantage bid process

• Knowledge and understanding of health plan network operations preferred

Experience to drive change

• Demonstrated track record of building strong working relationships across operational leaders and potential payor partners

• Bachelor’s degree required; a focus in Business preferred

• 20+ years in progressive roles required

• Demonstrated analytical, project management, and leadership skills

• Experience with and understanding of health care reimbursement methods

• Experience modeling payor contracts

• Knowledge of value-based contract methodologies and preferred financial and administrative terms

• Experience negotiating quality and efficiency metrics preferred

• Ability to think independently, and develop new processes/analyses required

• Strong organizational skills with the ability to multi-task and execute against multiple competing priorities

• Proficiency in Excel, PowerPoint, and Word required

This is an exempt position. The base compensation range for this role is $220,800 to $280,100. At VillageMD, compensation is based on several factors including, but not limited to education, work experience, certifications, location, etc. The selected candidate will be eligible for a valuable company benefits plan, including health insurance, dental insurance, life insurance, and access to a 401k plan.

About Our Commitment Total Rewards at VillageMD

Our team members are essential to our mission to reshape healthcare through the power of connection. VillageMD highly values the critical role that health and wellness play in the lives of our team members and their families. Participation in VillageMD’s benefit platform includes Medical, Dental, Life, Disability, Vision, FSA coverages and a 401k savings plan.

Equal Opportunity Employer

Our Companyprovides equal employment opportunities ( EEO) to all employees and applicants for employment without regard to, and does not discriminate on the basis of, race, color, religion, creed, gender/sex, sexual orientation, gender identity and expression (including transgender status), national origin, ancestry, citizenship status, age, disability, genetic information, marital status, pregnancy, military status, veteran status, or any other characteristic protected by applicable federal, state, and local laws.

Safety Disclaimer

OurCompanycares about the safety of our employees and applicants.Our Companydoes not use chat rooms for job searches or communications.Our Companywill never request personal information via informal chat platforms or unsecure email.Our Companywill never ask for money or an exchange of money, banking or other personal information prior to the in-person interview. Be aware of potential scams while job seeking. Interviews are conducted at selectOur Companylocations during regular business hours only. For information on job scams, visit, https://www.consumer.ftc.gov/JobScams or file a complaint at https://www.ftccomplaintassistant.gov/ .