Vice President, Payment Innovation

Location: Clayton, MO
Position Purpose: Develop, implement and maintain provider financial incentive models. Provide analytical support for contract negotiations and reimbursement development, focusing on lowering unit cost, improving the quality of care, and increasing member and provider network satisfaction. Lead complex enterprise wide initiatives to improve network performance. 
  • Serve as enterprise subject matter expert on provider incentives relating to payment innovation, including evaluating current models and determining effectiveness
  • Design, build and maintain complicated statistical risk and saving models Develop presentations and materials detailing methodology, analysis and results to communicate payment programs to varied audiences
  • Direct the health plan leadership team in identifying cost savings, contracting opportunities and performance improvement initiatives
  • Develop and oversee intricate reimbursement strategy plans for all health plans
  • Develop and implement reimbursement policy changes to pursue cost savings
  • Collaborate with appropriate departments on the development and support of analytic tools to measure and monitor provider reimbursement and incentive programs
  • Ensure all processes of Medicaid, Medicare and Commercial Reimbursements meet state and federal guidelines
  • Design and implement new reimbursement methodologies for all products
  • Ensure the development and implementation of plans, provide business architecture for network imbursement and performance, including training, documentation, standards, roles, and responsibilities and new market operations
  • Manage the development of contracting standards and guidelines for various payment rules in provider contracts
  • Review results post-implementation to ensure projected cost savings are realized and recommend modifications as applicable
  • Up to 30% travel
  • Bachelor's degree in Finance, Hospital Administration, Business or related field. Advanced degree preferred.
  • 10+ years of healthcare provider contracting management, network development/management, and reimbursement experience in a healthcare or managed care environment.
  • Familiarity and knowledge of contracting language standards and guidelines and principles of negotiation.
  • Strong financial and analytical skills.
  • Previous management experience including responsibilities for hiring, training, assigning work, motivating a team, and managing performance of staff.
Preferred skills:
  • Deep understanding/knowledge of value-based purchasing (VBP)/payment innovation models with experience leading design, development and implementation of VBP programs across markets, products
  • Excellent presentation/communication skills; to C-suite and all levels of company. Will be primary lead for VBP strategies
  • Ability to develop VBP strategy across markets/products, and lead implementation of future state VBP operating model
April A. Estes
Senior Recruiter
720-439-2609 Direct
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