Senior Value Based Care Contracting Payor Relationship Manager FL Plantation, FL Business Office Full Time - Days Corporate Req #: 17521 Posted: November 4, 2024 Apply Now Save Job Saved

Summary

Pediatric Associates was founded in Hollywood, FL in 1955. The same clinician-led, evidence-based, medical home passion is a unifying driver for those who join Pediatric Associates Family of Companies. The Pediatric Associates Family of Companies is a growing team of Pediatricians and Pediatric Care Teammates who are excited to be part of the first nationwide Pediatric Primary Care Medical Home. We further our uniqueness by ensuring the clinician voice is leading our medical home innovations.
 

PRIMARY FUNCTION

The Florida Senior Payor Relationship Manager is responsible for managing all payor relationships and possesses an in-depth understanding of the payor landscape for the Florida market. This position facilitates the successful resolution of all outstanding contractual and operational issues identified by internal PA Family of Companies members. This position works closely with the Director, Managed Care Operations and directly reports to the Director of Payor Partnerships for the Florida market.

 

ESSENTIAL DUTIES AND RESPONSIBILITIES

This list may not include all of the duties that may be assigned.

Develops and maintains strong payor relationships to serve as the primary PA Family of Companies payor relationship owner, operations resolution facilitator and strategic growth thinker for the Florida market. Initiates and maintains effective channels of communication with all payors. Coordinates and facilitate all VBC and large complex payor JOC meetings to ensure execution of strategic performance and shared growth initiatives in the Florida market. Partner and assist internal stakeholders in monitoring payor contract performance and identifying areas of growth and performance opportunities, to include Capitation, Gainshare, Pay for Performance, and Incentive Programs. Must have an in-depth understanding of value-based care and proactively monitor the Florida payor landscape, including extensive knowledge of Florida Medicaid programs, to maximize the competitive position of the PA Family of Companies. Supports the Director of Payor Partnerships in Value-Based, Medicaid and Fee for Service negotiations to ensure compliance with PA Family of Companies contract standards and financial metrics.  Initiates and maintains effective channels of communication with matrix partners to vet contract impact, including but not limited to Claims, Credentialing, Legal, Medical Economics, Revenue Cycle, Regional Operations, Compliance, Medical Management.  Tracks and manages the full life cycle for all payor contracts and amendments from beginning to counter-execution for all contracts which includes Risk, Value Based, Fee for Service, and Capitation payment methodologies. Monitors, evaluates, and assists Managed Care Operations in the resolution of payment inconsistencies for all contractual arrangement and payment methodologies in the Florida market. Assist Managed Care Operations with the resolution and escalation of all claim and payment issues, contract and roster loading, payor communications, and other requests as received from the payor community. Coordinates with Managed Care Operations to ensure compliance with state and federal regulations for contract terms and legal regulations that may impact contract performance .  Must be an individual contributor able to work in a highly matrixed role.  Must work by influence/building relationships with internal and external partners ensuring effective and positive relationships. Other Duties as assigned.

 

QUALIFICATIONS

EDUCATION:

•    A bachelor’s degree in healthcare administration or business is required. Master’s degree preferred.

•    A minimum of 5 years of related experience will be commensurate with education.

EXPERIENCE:

Minimum of 5 years’ of combined payor and provider experience required. Previous healthcare experience required.

 

KNOWLEDGE, SKILLS AND ABILITIES

In-depth understanding of contract language, complex contract reimbursement methodologies, and evaluating contract performance.  Proficient in commercial, Managed Medicaid, risk and value based reimbursement structures, payment methodologies, and operations. Effective strategic planning and organizational skills In-depth knowledge of Statewide Medicaid Managed Care programs and Commercial payors Proficient in research, analysis, and interpretation of financial data and trends Knowledge of claims, credentialing, and loading processes Experience in developing and managing relationships across a cross-functional and matrixed environment. Effective communicator to internal and external audiences, including executives, balanced with strong interpersonal skills. A team player with experience in complex environments with the ability to build consensus among divergent interests and competing organizational needs. Advanced Microsoft Office skills Effective oral and written communication and negotiating skills. Ability to manage multiple priorities and projects. Ability to influence others

 

LICENSURE/CERTIFICATION:

*Upon hire, and for the duration of the employment period driver’s license must be active and valid.*

 

TYPICAL WORKING CONDITIONS

Non-patient facing May be either full time remote or rotate working in the office. Must be U.S.-based. Indoor Work Operating Computer Reach Outward Reach above Shoulder Lift/Carry 11-20lbs. Standing Sitting Traveling Walking Bending Manual Dexterity

OTHER PHYSICAL REQUIREMENTS

Vision Sense of sound Sense of touch   The Pediatric Associates Family of Companies an Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. Share: Apply Now