National Director Payor Contracts

Ameritox   •  

Virtual / Travel

Industry: Healthcare IT

  •  

11 - 15 years

Posted 396 days ago

POSITION SUMMARY

 

The National Director, Payor Contracts (ND) is responsible for cultivating and maintaining solid Payor relationships (local/regional/national) within an assigned territory, and is the primary liaison between Payors and Ameritox, providing timely updates to key internal staff and soliciting input to ensure a global strategic approach with a Payor.

 

Specifically, the ND will lead Ameritox in the development and implementation of effective Payor contracting strategies, aligning various resources as necessary; negotiate agreements that drive business growth and achieve overall financial goals; ensure all Payor contracts are managed in accordance with Ameritox standards.  S/he will lead and/or support necessary contract administrative processes, seeking appropriate contract approvals. S/he will monitor contract performance and take corrective action(s) to resolve operational issues.  The ND will lead our Payor service initiatives to ensure we are seen as an active and trusted Payor partner.

 

The position also requires the ability to work both independently and drive collaboration as part of a team, embrace change, think creatively and demonstrate excellent interpersonal, verbal and written communication skills.

 

ESSENTIAL DUTIES AND RESPONSIBILITIES

  • Develop, implement and align Payor strategies with overall company direction and corporate goals. Analyze, evaluate and define global Payor approach.  Prioritize Payor targets to maximize value for Ameritox and those we serve. 
  • Proactively identify and recommend new growth opportunities (primarily within the Payor community), creating the required business case and gaining approval.

  • Develop strong partnerships with target Payor organizations that help Ameritox achieve revenue/EBIDTA goals.Activites/Responsibilities include:

    • Act as the primary liaison between Ameritox and Payor organizations, strengthening our overall relationship and creating mutual loyalty.

    • Determine important Payor contacts at various levels within the health plan, and engage key Ameritox employees to establish relationships with peer counterparts.

    • Evaluate existing Payor agreements and create opportunities to further enhance business value and financial growth.

  • Responsible for management of financial, operational and contract analysis of Payor agreements; monitor Payor information including: quarterly reports, contracts trends, cost, profitability and overall contract compliance.

  • Serve as primary project manager relating to Payor initiatives defining project scope, coordinating internal team, establishing timeframes, gaining approval, managing implementation and monitoring results.

  • Provide market knowledge to assist in the development of systems, gather key data resources and/or acquire analytical tools necessary to better evaluate the Payor market.Work to enhance marketing materials that aide in Payor outreach.

  • Work collaboratively with other departments to create a collaborative environment and fully leverage positive impact of Payor initiatives.Activities will include:

    • Interact with Patient Financial Services to implement, manage and monitor Payor contacts;

    • Work collaboratively with Sales/Marketing to connect Payor, provider and related marketing strategies.

    • Identify and recommend appropriate operational changes to achieve maximum efficiency with Payor contracts.

  • Successfully perform other duties or special projects as assigned.
  • Adhere to confidentiality (HIPAA) requirements (patient files and personal information).

 

SUPERVISORY RESPONSIBILITIES:  

 

 Not applicable initially, but may change over time.

 

EDUCATION/EXPERIENCE

 

  • Bachelor's degree or equivalent in a business or related field; Advanced degree (e.g., MBA) is strongly preferred.

  • Ten or more years of experience negotiating and managing healthcare services and/or contracts with Payors.

  • Health Plan, Diagnostic Solutions Provider or related industry experience creating/implementing effective Payor growth strategies strongly preferred.

  • Demonstrated experience developing strategies and creating and implementing tactics to achieve goals in support of these strategies.

     

OTHER REQUIRED QUALIFICATIONS

 

  • Ability to travel a significant amount – likely between 75% to 90% of the time.

  • Strategic and creative thinker;strong research, analysis and presentation skills; results oriented approach

  • Excellent communication skills, both writen and oral

  • Must be a self-starter, highly organized, and able to work well with staff at all levels in the organization

  • Demonstrate leadership, develop strong partnerships, lead change and drive execution.

  • Understand customer demands and promote a service mentality

  • Accept accountability and maintain integrity

  • Effective analytical, expense and budget management

  • Working knowledge of Microsoft Office and project management processes

  • Experience in financial modeling tools will be considered a plus