Director, Alternative Payment Model Performance

This is a fully remote position, open to applicants in United States.

📋 Description

• Manage vendor contracts related to medical and medical administrative services, shared savings programs, supplemental benefits, and the costs associated with quality reclassification administration.

• Work closely with IT, Claims, and Operations teams to ensure the proper administration of contract operational elements.

• Create and oversee policies and procedures pertaining to vendor contracts, covering payments, reconciliation, invoicing, capitation payments, and shared savings programs.

• Drive financial strategy during vendor contract negotiations, ensuring that vendor payments comply with MLR reporting and rate development standards.

• Formulate the Finance vendor contract strategic plan and Value-Based Purchasing strategy.

• Set performance metrics, guarantee return on investment, and meet financial and quality objectives.

• Ensure that Accounting has precise information to process contract payments, including cost centers and vendor-cost classifications.

• Promote cost savings and efficiencies through vendor consolidation and remediation efforts.

• Maintain a database of contract provisions and outcomes to evaluate cost structures, variability, and best practices.

• Oversee month-end activities, including administrative accruals, variance analysis, reporting, risk identification, and communication with senior management.

• Assist with forecasting, budgeting, long-term financial projections, and strategic planning initiatives.

• Support pro forma analysis for RFPs, new business ventures, and annual product pricing adjustments.

• Lead vendor due diligence for potential mergers and acquisitions opportunities.

• Cultivate relationships with key vendor contacts, negotiate advantageous terms, acquire files for MLR calculations, rate setting, and encounter reporting, and ensure adherence to financial contract terms.

• Recruit, train, develop, and evaluate staff members.

⛳️ Requirements

• Bachelor of Science/Arts (BA/BS) degree in Finance, Accounting, Mathematics, or a related field.

• At least ten (10) years of relevant experience.

• A minimum of five (5) years of experience in a management role.

• Previous experience in the healthcare or insurance sector.

• Proficient in PC applications, particularly advanced skills in Excel, Word, and PowerPoint.

• Exceptional oral, written, and interpersonal communication abilities.

• Strong analytical and problem-solving capabilities.

• Ability to effectively influence and persuade others.

• Robust managerial and team-building skills, with the capacity to lead and direct others' work.

• Strategic thinking abilities coupled with strong financial insight.

• Documented history of achievement and integrity.

• Licensure/Certification: None required.

• An MBA is preferred.

• Experience with organizations that encompass both for-profit and not-for-profit entities is preferred.

🏝️ Benefits

• Bonus opportunities based on company and individual performance may be available.

• Comprehensive and substantial total rewards package.

• Total well-being benefits offered.

• Remote work flexibility.

• Occasional travel required.