EMERGEORTHO, P.A.
Director of Payor Relations
EMERGEORTHO, P.A., Durham, North Carolina, United States, 27703
Director of Payor Relations
Classification: Exempt
Responsible To: Chief Financial Officer
EmergeOrtho offers a comprehensive salary and benefits package. Salary is negotiable. Flexibility in working remotely, in the office, or both.
Job Summary: The Director of Payor Relations is responsible for integrating and aligning managed care payor strategy with EmergeOrtho's strategic objectives. Success will be evident in revenue generation achieved through managed care payor contracting, value-based contract performance, commercial bundles, effective contract management, and market strategy innovation while delivering affordable access, price transparency, and service excellence.
Demonstrated success in the following:
Ability to exercise a high degree of initiative, judgment, discretion, and decision-making to achieve the organization's mission Analyzing situations accurately and taking effective action Establishing and maintaining effective working relationships with payors Organizing work, delegating, and achieving goals and objectives Effective organization and integration of organizational priorities and deadlines
Analysis and development of comprehensive measurement reports Effective communication and collaboration among physicians, staff, payor relationships, government officials, and the public Knowledge of relevant health care laws and regulations Exceptional organizational, communication, and problem-solving skills Ability to make decisions quickly if needed; ability to prioritize multiple competing demands
Advanced knowledge of Microsoft Office, including Excel and PowerPoint
Responsibilities include, but are not limited to:
Responsible for strategic and operational integration activities of managed care payor strategy across EmergeOrtho, to include oversight of, and collaboration with, the following managed care functions: payor strategy, value-based contracting strategy, contract management and operations, and commercial bundles Implement and monitor the success of payor strategies to drive sustainable financial performance. Develop and maintain enterprise value-based contracting strategies and implementation guardrails that lower total cost of care, improve population health and drive growth & sustainable financial performance.
Oversee managed care contract maintenance, access, and operational management processes and activities. Monitor, analyze, and provide strategic insights on CMS reimbursement & payment policy changes impacting managed care contracts & payor strategies. Lead and deliver research, analysis, and payor strategy development activities to support successful strategy execution and merger/acquisition/divestiture transactions. Demonstrate concrete and relevant revenue linkages between payor contracts, value generation to customers, and objectives. Lead and advocate for new innovative products, develop a business rationale for Medicare Advantage, and other appropriate opportunities
Maintain professional affiliations and enhance professional development to keep current with the latest health care trends .d developments?? Prepare agendas, reports, and presentations for the committee, board, and shareholder meetings; lead discussions and coordinate subsequent changes. Write and respond to a high volume of emails in a prompt manner; place and retrieve many phone calls daily.
Work Environment The work environment characteristics described here represent those an employee encounters while performing the essential functions of this job. ?Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions. ?The noise level in the work environment is usually moderate such as found in a normal business office with computers.
Physicial Demands The physical demands described here represent those that must be met by a member to successfully perform the essential functions of this job. ?Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions. While performing the duties of this job, the employee is frequently required to sit and talk or listen. ?The member is frequently required to walk; use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms; climb or balance; and stoop, crouch, and kneel. The employee must be able to occasionally lift and/or move up to 25 pounds. ?Specific vision abilities required by this job include close, distance, color, peripheral vision, and the ability to adjust focus.
EmergeOrtho offers a comprehensive salary and benefits package. Salary is negotiable. Flexibility in working remotely, in the office, or both.
Job Summary: The Director of Payor Relations is responsible for integrating and aligning managed care payor strategy with EmergeOrtho's strategic objectives. Success will be evident in revenue generation achieved through managed care payor contracting, value-based contract performance, commercial bundles, effective contract management, and market strategy innovation while delivering affordable access, price transparency, and service excellence.
Demonstrated success in the following:
Ability to exercise a high degree of initiative, judgment, discretion, and decision-making to achieve the organization's mission Analyzing situations accurately and taking effective action Establishing and maintaining effective working relationships with payors Organizing work, delegating, and achieving goals and objectives Effective organization and integration of organizational priorities and deadlines
Analysis and development of comprehensive measurement reports Effective communication and collaboration among physicians, staff, payor relationships, government officials, and the public Knowledge of relevant health care laws and regulations Exceptional organizational, communication, and problem-solving skills Ability to make decisions quickly if needed; ability to prioritize multiple competing demands
Advanced knowledge of Microsoft Office, including Excel and PowerPoint
Responsibilities include, but are not limited to:
Responsible for strategic and operational integration activities of managed care payor strategy across EmergeOrtho, to include oversight of, and collaboration with, the following managed care functions: payor strategy, value-based contracting strategy, contract management and operations, and commercial bundles Implement and monitor the success of payor strategies to drive sustainable financial performance. Develop and maintain enterprise value-based contracting strategies and implementation guardrails that lower total cost of care, improve population health and drive growth & sustainable financial performance.
Oversee managed care contract maintenance, access, and operational management processes and activities. Monitor, analyze, and provide strategic insights on CMS reimbursement & payment policy changes impacting managed care contracts & payor strategies. Lead and deliver research, analysis, and payor strategy development activities to support successful strategy execution and merger/acquisition/divestiture transactions. Demonstrate concrete and relevant revenue linkages between payor contracts, value generation to customers, and objectives. Lead and advocate for new innovative products, develop a business rationale for Medicare Advantage, and other appropriate opportunities
Maintain professional affiliations and enhance professional development to keep current with the latest health care trends .d developments?? Prepare agendas, reports, and presentations for the committee, board, and shareholder meetings; lead discussions and coordinate subsequent changes. Write and respond to a high volume of emails in a prompt manner; place and retrieve many phone calls daily.
Work Environment The work environment characteristics described here represent those an employee encounters while performing the essential functions of this job. ?Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions. ?The noise level in the work environment is usually moderate such as found in a normal business office with computers.
Physicial Demands The physical demands described here represent those that must be met by a member to successfully perform the essential functions of this job. ?Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions. While performing the duties of this job, the employee is frequently required to sit and talk or listen. ?The member is frequently required to walk; use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms; climb or balance; and stoop, crouch, and kneel. The employee must be able to occasionally lift and/or move up to 25 pounds. ?Specific vision abilities required by this job include close, distance, color, peripheral vision, and the ability to adjust focus.