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Director of Payer Strategy

Revenue Cycle Management

  • Posted: 10 June 2021
  • Full-time
  • Phoenix, AZ, USA

At American Vision Partners (AVP), we’re bringing the best together. Our company was created with the affiliation of Barnet Dulaney Perkins Eye Center, Southwestern Eye Center, and M & M Eye Institute. We serve communities in Arizona, Nevada, New Mexico, California, Texas, and more to come!

Today we’re one of the nation’s largest and most comprehensive ophthalmology practices with more than 130 nationally renowned doctors across 70 locations, in addition to 20 ambulatory surgical centers and 25 satellite clinics. At AVP we are committed to best in class patient care, being a pioneer in research and technology, and most importantly, rewarding and recognizing our employees

Director of Payer Strategy 
AVP Admin: Phoenix location

The Director of Payor Strategy is responsible for managing all activities associated with network development, payor contracting and strategy, as well as provider network development.  Actively participates in strategic initiatives while playing a key role as a subject matter expert/key contact to internal and external customers. Responsible for cross promotion of physicians and programs to drive and increase market share.

Responsibilities:

  • Analyzes, evaluates and negotiates new and existing payor contracts.
  • Drive payor reimbursement and revenue growth to maximize value for organization.
  • Identifies provider targets for network development initiatives as well as maintaining adequate network coverage of existing specialties.
  • Develops and implements reimbursement models that maximize reimbursement (including incentive / risk & reward models as necessary), through collaboration with various departments, including clinical and finance departments.
  • Establish, manage, and maintain positive, strategic relationships with payors, employers, product distribution channels and providers as applicable the region.
  • Works closely with analytics teams in developing/establishing provider reimbursement models and parameters.
  • Ensures alignment of payor programs with the company's strategic business initiatives.
  • Stays current with managed care and regulatory issues in relation to health benefits, payor activity, contracting and reimbursement methodologies, products and delivery channels including health insurance exchanges, market competition, etc.
  • Collaborates with clinical team to influence and change adverse payor policies.
  • Monitor, assess, and measure the financial impact on the organization of prospective regulatory changes to Federal and State reimbursements.
  • Thought leader and subject matter expert regarding insurance operations and insurance.
  • Performs other duties as assigned.

Qualifications:

  • Bachelor's degree in Business Administration, Health Care Administration, Public Health Science or related discipline.
  • Minimum five years’ experience in the insurance or healthcare industry, with responsibility for negotiating contracts with healthcare providers and/or health plans.
  • Demonstrated experience with proven track record in physician network development, strategic and/or business planning, or payor contracting.
  • Excellent verbal, written and presentation skills.
  • Excellent PC skills; MS Access, Excel, Decision Support/Contract modeling/Reimbursement software or comparable PC based database skills required.
  • Extremely organized and detail oriented with exceptional follow through skills.
  • Ability to multi-task in a fast pace environment; can adapt quickly to change; have strong negotiation skills.
  • Ability to organize workload, manage multiple projects, and maintain confidentiality of all work information
  • Ability to establish and maintain effective working relationship with team members, clinic staff, payors and providers.

Benefits & Perks:

Your health, happiness and your future matters! At AVP, we offer everything medical and dental insurance, significant eye care discounts, child care assistance, pet insurance, continuing education funds, 401(k), paid holidays plus PTO, Sick Time, opportunity for growth, and much more!

We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.