VP, National Payer Contracting - Remote

About Sound:

Headquartered in Tacoma, WA, Sound Physicians is a physician-founded and led, national, multi-specialty medical group made up of more than 1,000 business colleagues and 4,000 physicians, APPs, CRNAs, and nurses practicing in 400-plus hospitals across 45 states. Founded in 2001, and with specialties in emergency and hospital medicine, critical care, anesthesia, and telemedicine, Sound has a reputation for innovating and leading through an ever-changing healthcare landscape — with patients at the center of the universe.

Sound Physicians offers a competitive benefits package inclusive of the items below, and more:

• Medical insurance, Dental insurance, and Vision insurance
• Health care and dependent care flexible spending account
• 401(k) retirement savings plan with a company match
• Self-managed PTO Plan
• Ten company-paid holidays per year

About the Role:

The Vice President of National Payer Contracting is a key strategic executive focused on meeting targeted growth objectives through effective relationships with local and national payers. This role is responsible for cultivating relationships, creating and executing on payer contracting strategies , which may include negotiating reimbursement rates and other payment related terms including case rates and risk based agreements with new and existing payers to meet target performance objectives. They will develop targeted strategic plans to support growth of the managed care portfolio and other objectives of Sound and its hospital partners, support the value based care initiatives, and collaborate across revenue cycle and business development lanes.

The Details:

This is a virtual, work from home role. This role requires travel up to 12-18 times per year.

In this role, you will be responsible for:

• Develop and implement comprehensive strategies for national payer contracting, encompassing fee-for-service, value-based, and risk-sharing arrangements.
• Lead contract negotiations with national payers to secure favorable reimbursement rates, terms, and conditions that support the financial sustainability and growth objectives of the organization.
• Collaborate with internal stakeholders, including executive leadership, clinical leadership, and operational teams, to ensure alignment of payer contracting strategies with organizational priorities and initiatives.
• Achieving growth, maximize net revenue, and ensure compliance through effective commercial contracting, contract payment, contracting management and recovery analysis.
• Participating in strategic design and implementation of overall Sound strategy for growing the managed care contract portfolio.
• Providing strategic approaches to maximization of profitable growth, improving efficiency and standardization through the use of industry best practices.
• Monitoring state and federal legislation related to payment initiatives and policy changes that could impact negotiations with health plans.
• Establishing and disseminating contracting guidelines with respect to third party payer contractual terms, reimbursement, provider enrollment, and product participation.
• Reviewing and presenting financial data, utilization trends, and patient mix needed to negotiate and re-negotiate payer contracts for all stakeholders across business lanes.
• Maintaining knowledge of payer products, enrollment statistics, and trends.
• Leading the team on maintaining client satisfaction through internal and external communication.
• Proactively pursuing innovative payment strategies for the top payers within a defined managed care market to include Value Based Contracting opportunities.
• Driving the research and analysis of business opportunities, including data analysis, proposals, projections, and related activities surrounding payer contracting.
• Resolving of escalated payer/client complaints which could affect Sound’s relationship with the payer.
• Developing internal reporting package and scorecard to quantify portfolio performance and areas of opportunity to increase profitability, including dispute resolutions with payers for timely filing and provider enrollment related rejections.
• Provide leadership, guidance, and mentorship to the payer contracting team, fostering a culture of excellence, collaboration, and continuous learning.
• Recruit, develop, and retain top talent within the payer contracting team, ensuring alignment of skills and expertise with organizational needs and strategic objectives.
• Performing other related duties and special projects as assigned.

What we are looking for:

A successful candidate will have a demonstrated track record of a combination of these values, knowledge, and experience:

Values:

• Strategic thinker:Demonstrates the ability to look at the big picture and proactively develop a plan of action.
• Customer-focused:Puts customer (internal and external) needs first and makes customers their top priority.
• Bias toward action:Has a focus on progress rather than perfection. Breaks things into bite-sized pieces in order to make progress against larger goals.
• Driven:Motivated to succeed and get things done at a high level of achievement
• Persistent:Demonstrates the ability to “keep at it” even when obstacles or challenges are present; returns to the work at hand after a change of course.

Knowledge:

• Bachelor’s degree in Healthcare Administration, Business, or Finance.
• Proficiency with Microsoft Office Suite.
• Extensive knowledge of payer contracting and payment systems.

Experience:

• 10+ years’ experience working as a Senior Executive in a payer contracting/reimbursement environment with direct oversight of contract negotiation staff.
• Experience working in both payer and provider environments preferred.
• Healthcare payment methodology operations experience required.

Sound Physicians is an Equal Employment Opportunity (EEO) employer and is committed to diversity, equity, and inclusion at the bedside and in our workforce. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, gender identity, sexual orientation, age, marital status, veteran status, disability status, or any other characteristic protected by federal, state, or local laws.

This job description reflects the present requirements of the position. As duties and responsibilities change and develop, the job description will be reviewed and subject to amendment.