Regional Senior Payor Relationship Manager

PRIMARY FUNCTION

The Senior Payor Relationship Manager is responsible for managing all payor relationships and possesses an in-depth understanding of the payor landscape for assigned markets. This position facilitates the successful resolution of all outstanding contractual and relationship management issues identified by either the payor or by internal PA Family of Companies members. This position reports directly to the Director of Contracting & Payor Partnerships and works closely with the Payor Enablement and market teams.

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, resolution facilitator and strategic thinker for assigned market(s).

Initiates and maintains effective channels of communication with all payors. Coordinates and facilitates payor meetings to ensure execution of strategic performance and shared growth initiatives. Partners and assists internal stakeholders in monitoring payor contract performance and identifying areas of growth and performance opportunities, including contracting opportunities spanning Capitation, Gainshare, Pay for Performance, and Incentive Programs.

Leads Fee for Service and supports Value-Based negotiations across Medicaid, Commercial, and IFP lines of business 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 the following areas: Claims, Credentialing, Legal, Medical Economics, Revenue Cycle, Regional Operations, Compliance, and Medical Management. Tracks and manages the full life cycle for all payor contracts and amendments from beginning to counter-execution across all payment methodologies.

Monitors, evaluates, and assists Payor Enablement team in the resolution of payment and other operational inconsistencies for all contractual arrangement and payment methodologies in assigned market(s). Ingests issues from payors and serves as primary point of contact and communication liaison internally and externally.

Proactively monitors the payor landscape to maximize the competitive position of the PA Family of Companies.

Coordinates with Payor Enablement and Compliance teams 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 value-based contract performance
• Proficient in commercial, Managed Medicaid, risk and value-based reimbursement structures, payment methodologies, and operations management
• Experience negotiating payor agreements
• Effective strategic planning and organizational skills
• In-depth knowledge of Medicaid Managed Care programs and Commercial payor landscape
• Knowledge of claims, credentialing, and loading processes
• Experience in developing and managing relationships across a cross-functional and matrixed environment
• Proficient in research, analysis, and interpretation of financial data and trends
• 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 skills
• Ability to manage multiple priorities and projects
• Ability to influence others

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

OTHER PHYSICAL REQUIREMENTS

• Vision
• Sense of sound
• Sense of touch

PERFORMANCE REQUIREMENTS

Adhere to all organizational information security policies and protect all sensitive information including but not limited to ePHI and PHI (Protected Health Information) in accordance with organizational policy, Federal, State, and local regulations.