SVP, Payor Strategy

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

📋 Description

• Develop and implement a comprehensive multi-year strategy for payors across commercial, Medicare Advantage, and Medicaid managed care plans.

• Oversee contracting for affiliated professional corporations within the MSO framework.

• Evaluate market trends, payor behaviors, and competitive positioning to determine contracting priorities.

• Drive negotiations, renewals, and amendments of fee-for-service agreements.

• Enhance rates, fortify contract terms, and minimize administrative burdens.

• Create contract strategies for professional services, imaging, and laboratory fee schedules.

• Address issues related to prior authorization, site-of-service, and ancillary billing terms.

• Manage escalations, disputes, and strategies for contract termination.

• Monitor compliance with contracts, identify underpayment issues, and mitigate reimbursement leakage in collaboration with Revenue Cycle and Finance teams.

• Design, negotiate, and expand value-based care arrangements and alternative payment models.

• Model the financial and operational impacts of proposed arrangements and suggest appropriate structures.

• Track quality, utilization, and cost benchmarks, capturing earned incentives.

• Structure payor arrangements for new markets and service lines.

• Cultivate relationships with health plan leadership in both current and expanding markets.

• Conduct payor due diligence for potential practice acquisitions and affiliations.

• Review contracts, rate benchmarks, assignment and change-of-control provisions, and reimbursement risks.

• Guide the onboarding process for newly affiliated practices with payors.

• Provide reimbursement assumptions and synergy estimates for deal modeling and integration planning.

• Maintain payor performance scorecards that cover rates, contract profitability, VBC performance, and denial trends.

• Present insights and recommendations to the Chief Growth Officer, executive leadership, physician leadership, and the Board.

• Keep abreast of federal and state reimbursement policies, CMS rulemaking, and changes in payor policies.

• Advise on the business implications of these changes.

• Oversee a small team dedicated to supporting contracting and payor analytics.

• Report directly to the Chief Growth Officer and act as a strategic advisor to executive leadership, Finance, Revenue Cycle, Operations, and physician leaders.

⛳️ Requirements

• Bachelor's degree is required.

• 12+ years of experience in payor contracting, managed care, or reimbursement strategy, with substantial provider-side experience.

• Experience in contracting for a multi-site physician group, MSO, practice management organization, or ambulatory provider platform.

• Proven track record of leading complex, multi-payor negotiations at the executive level.

• Expert knowledge of contracting and reimbursement methodologies for commercial, Medicare Advantage, and Medicaid managed care.

• Demonstrated leadership capabilities, including the ability to build, develop, and hold accountable a lean, high-performing team.

• Success in negotiating FFS rate enhancements and VBC arrangements for provider organizations.

• Strong financial modeling and analytical competencies.

• Comprehensive understanding of MSO and PC structures, including payor contracting within them.

• Working knowledge of revenue cycle, credentialing, and physician practice operations as they relate to reimbursement performance.

• Executive presence with strong relationship management skills with health plan leadership, physicians, and deal teams.

• Ability to work independently and achieve results in a fast-paced, private equity-backed environment.

• Experience in an MSO or private equity-backed physician practice management setting is strongly preferred.

• Experience supporting M&A diligence and post-close integration of physician practices is preferred.

• Payor contracting experience and established relationships in health plans in New Jersey, Pennsylvania, Indiana, and/or Kentucky is preferred.

• Experience in women's health or related specialties is preferred.

• Payor-side experience in network management or provider contracting is preferred.

• An MBA, MHA, MPH, JD, or related advanced degree is preferred.

• Applicants must be authorized to work in the United States on a full-time basis.

• Must complete employment eligibility verification upon hire.

🏝️ Benefits

• 401(k) with company match.

• Generous PTO offering, including additional time off for volunteering.

• Multiple medical insurance options available.

• Access to Axia providers at minimal or no cost through Axia’s medical insurance.

• Company-paid life insurance.

• Short-term and long-term disability insurance.

• Complimentary counseling services for colleagues and their family members, including parents and parents-in-law.

• Discounts on hotels, theme parks, gym memberships, and more via the Great Works Perks Program.

• Dental insurance.

• Vision insurance.

• Supplemental life insurance.

• Flexible Spending Account (FSA).

• Health Savings Account (HSA) with employer contribution.

• Identity theft insurance.

• Long-term care insurance.

• Pet insurance.