VP, Reimbursement, Contracting and Value Based Payments

Purpose:
The Vice President of Contracting, Reimbursement and Value Base Payments is a high-level management position responsible for the day-to-day operations of the Reimbursement and Contracting and Value Based Contracting Department. The position will be responsible for maintaining the contractual relationship with providers, ensuring timely and cost-effective negotiation/renegotiation of provider rates and contracts, accurate configuration of claims payment system, and the development and maintenance of all expansion networks. This position will be integral to creating the strategy and implementation of all alternative payment model.

Responsibilities:

• Direct the negotiation/renegotiation of all hospital, physician and ancillary payment rates.
• Coordinate contracting/re-contracting efforts for all hospitals, physicians and ancillary providers.
• Administer the creation of reimbursement schedules for hospital, physician and ancillary providers.
• Ensure schedules are competitive in the market and actuarially sound based on the premiums being offered to employer groups.
• Research, develop and lead implementation of new reimbursement and contracting methodologies.
• Responsible for all contracting and relationship management for entire delivery system including facility, physician and ancillary providers.
• Oversee the maintenance of fee schedules for updates, distributions and retention.
• Direct the ongoing analysis and comparison of reimbursement schedules to ensure market competitiveness.
• Responsible for updating HIPAA compliant code set to ensure regulatory compliance.
• Ensure all code bundling software is in compliance with CCI and AMA editing regulations.
• Establish and maintain positive relationships with executives of Hospitals, PHOs, POs, and Physician offices.
• Report to Sr Vice President of Network Strategy and Performance actual network utilization patterns to budgeted expectations to make recommendations regarding risk/incentive contracts.
• Supervise duties and functions of Reimbursement Specialists, Analysts and Value Based Specialists.
• Work with management personnel from all areas of health plan on any issues pertaining to provider reimbursement, provider contracting or network expansion.
• Lead reimbursement/contracting division in developing and implementing effective strategies for network expansion and relationship management.
• Work with VP National Network Development to coordinate and maintain a network expansion strategy that supports growth and expansion needs for all UPMC HealthPlan products.
• Develop and maintain effective communications with all impacted areas.
• Lead Reimbursement, Contracting and Value Based Contracting team.
• Ensure excellent service to providers. Ensure team integrates with and supports other internal divisions as necessary.

Qualifications:

• Bachelor's Degree is required. Master's Degree preferred.
• Three to five years management experience with either a physician practice, hospital, ancillary provider, health insurance company or integrated delivery system is required.
• Individual needs to have understanding of managed care delivery system and have had direct experience with reimbursement.
• Knowledge of ICD-9CM, CPT-4 and HCPCS coding and related governmental guidelines and provider reimbursement methodologies is also necessary.
• Individual needs to have excellent written and verbal communication skills, ability to prioritize projects, proficiency in utilizing PC based system applications and ability to negotiate reimbursement agreements.
• Well-developed analytical and problem-solving skills.
• Ability to work cooperatively with multidisciplinary teams and/or independently.
• Experience in negotiating hospital reimbursement agreements directly with providers.
  UPMC is an Equal Opportunity Employer/Disability/Veteran