JOB TITLE: Senior Director, Payer Contracting

DEPARTMENT: Payer Operations

LOCATION: Remote

EMPLOYMENT TYPE: Full Time

Overview of the Role:

The Senior Director, Payer Contracting is responsible for all aspects of payer contracting for Privia Health for designated payers and/or Privia Markets. This includes but is not limited to, development of contract strategy, negotiation, analysis and administration of all fee-for-service and risk/incentive-based payer contracts. The position also collaborates with senior leadership in Business Development, Healthcare Economics and Value Based Care to identify and analyze contracting strategy and expansion opportunities (e.g., entrance into new markets through the development of new payer relationships).

Primary Job Duties:

• This position will have significant revenue responsibilities and will require a high level of understanding of healthcare financing and delivery as well as the ability to think strategically and offer innovative solutions to complex challenges.
• Participate directly and oversees activities of strategy development, contract negotiations, contract language, risk assessment, contract amendments, financial analysis, payer performance monitoring, contract operationalization, payer relations and issue resolution.
• Execute strategies and tactics developed jointly with Privia leadership in designated markets and reports on payer performance. Identifies and implements leading practices and processes to increase revenue and achieve objectives.
• Present, collaborate and reach consensus with physician governance committees on strategy, tactics and results.
• Create presentations and deliver updates to senior leadership in a professional manner.
• Build and maintain positive relationships with designated Privia markets, corporate resources and managed care payers.
• Monitor state and federal legislation related to payment initiatives and policy changes that could impact negotiations.
• Assess and review risks and opportunities across the enterprise related to payment reform, value-based purchasing, etc.
• Work closely with VP, Payer Contracting to establish a standard practice with guidelines, processes (including legal review), and workflows. Utilize the standard guidelines and processes for negotiation of third party payer contractual agreements, reimbursement rates, etc.
• In conjunction with SVP of Business Development and others, evaluate and analyze new market expansion opportunities including collaboration, design and key driver assumptions for supporting financial models.
• As needed, assess and assist in development of key components of CIN to create value for Privia, physicians, payers, and consumers.
• Perform other duties as assigned

Minimum Qualifications:

• Bachelor’s Degree required; Master’s Degree preferred
• 10+ years of healthcare experience, a significant portion of which working with managed care and other payers
• Comprehensive knowledge of healthcare finance as well as managed care and insurer contracting including commercial and Medicare Advantage payer relations
• Significant experience in managed care contract terminology and reimbursement negotiations
• Outstanding conceptual, analytical and problem solving skills comfortable operating within actuarial/analytical organization
• Strong managerial acumen in setting direction and managing execution to achieve goals and a strong desire to manage, develop and mentor other teammates or colleagues
• Knowledge of best practices in revenue cycle environment
• Results oriented with strong analytical skills and excellent Microsoft excel skills
• Effective negotiator or consensus builder, as is necessary
• Must comply with HIPAA rules and regulations

Interpersonal Skills & Attributes:

• A high level of integrity, trust and ethics
• A willingness to listen, succinctly debate and evaluate issues with an open mind to different opinions and approaches to problem solving
• Strong presentation and communication skills, with the ability to communicate to a wide range of audiences from senior executives to front-line employees
• Demonstrated ability to assess current processes and implement best practices
• Ability to engage directly with senior level executives
• Strong influencing skills; track record of successful client relationship development and ability to quickly build credibility and gain the confidence of individuals at all levels
• Strong sense of accountability; passion for owning projects and driving them to completion
• Team player with the ability to sell change effectively and influence others
• Ability to effectively drive multiple projects
• Ambitious and proactive with strong team leadership skills and drive to “get stuff done”

Physical Demands:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools or controls; talk or hear. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus.

Privia Health is committed to providing equal employment opportunity to all persons regardless of age, color, national origin, citizenship status, physical or mental disability, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status, or any other characteristic protected by federal, state or local law. In addition, Privia will provide reasonable accommodations for qualified individuals with disabilities. Privia’s goal is for our people to reflect the communities that we serve and to increase representation of women, people of color, veterans and individuals with disabilities in our organization.