31 Jan
Vice President, Payor Strategies
Texas, Houston , 77001 Houston USA

The mission of The University of Texas MD Anderson Cancer Center is to eliminate cancer in Texas, the nation, and the world through outstanding programs that integrate patient care, research and prevention, and through education for undergraduate and graduate students, trainees, professionals, employees and the public.Under the direction of the SVP and Chief Financial Officer, the Vice President is responsible for the development and implementation of hospital and physician managed care contracting strategy, including negotiation and management of third-party payor (government and private). The VP collaborates with executive leadership, senior management, and clinical operation leaders in the development of this strategy for locations within the Texas Medical Center/Houston Area Locations as well as for Austin or any other locations.Collaborate with institutional leaders in assessing future needs for managed care and service offerings. Develop a visionary direction and formulate long-term sustainable goals, both for commercial insurance products as governmental plans. Actively involved in the managed care industry, including both state and national organizations, keep abreast of policy and legislative innovations and developments. Formulate strategies for new opportunities. Work with senior leaders to model management performance and develop successful and sustainable long term managed care leadership team, core skills and supporting systems, analytic tools and comprehensive data feeds.The VP will provide capable leadership for the following functions: managed care contracting, clinical revenue and reimbursement including Medicare cost reporting. Will partner with compliance and legal to ensure that all processes are appropriately managed in accordance with MD Anderson standards and federal and state regulatory requirements. Works closely with Government Relations to develop strategies to optimize reimbursement from State and Federal programs.KEY FUNCTIONSManages negotiation, oversight and operational implementation of all payor and managed care organization agreements:▪ Representing hospitals and physician practices develops, evaluates, and implements strategies for establishing reasonable payor and managed care organization relationships.▪ Develops standardized contract language terms and acceptable payment rates that are consistent with MD Anderson financial and legal guidelines and overall contracting goals.▪ Ensures that contracts optimize pricing and strategically align hospital and physician incentives. Such contracts will account for the range of pre-eminent services and international standing offered by the institution.▪ Protects enterprise from contracting exclusions, redirection by payers and erosion of range of services available to patients.▪ Manages the development of data bases and analytical tools to assist in the negotiation of contracts and the tracking, analysis and reporting of contract performance.▪ Works with senior management, clinical operations leaders and other appropriate personnel to ensure that MD Anderson meets contractual obligations.▪ Works with MD Anderson leadership to develop long-range forecasts given anticipated and realized contract rates and language terms.▪ Oversees the timely and effective implementation of contracts through communication with health plans and others as appropriate.▪ Oversees development and negotiation of Letters of Agreement, as needed.▪ Analyzes and reports contract performance and industry trends to senior management and clinical operation leaders on a periodic basis.▪ Collaborates with MD Anderson Government Relations to develop strategies to optimize reimbursement from state and federal programs.Management and Oversight for chargemaster, revenue integrity and reconciliation:▪ Oversees and coordinates strategic pricing and price transparency efforts, including modeling and assessment of impacts to pricing on anticipated net revenue.▪ Collaborates with Internal Audit and Financial Controls to provide institutional support for charge capture training and reconciliation.▪ Ensures revenue integrity through regulatory compliance, loss prevention, and revenue monitoring▪ Oversees the chargemaster, related pricing, charge triggers and code updates▪ Prepare managed care and clinical revenue and reimbursement personnel and systems for Austin expansion through thoughtful collaboration and partnership with all institutional stakeholdersWorks closely with MD Anderson Finance team to ensure aligned approach on Finance workstreams, including:▪ Ensures service line reporting and analytics reflect managed care contracting strategies▪ Incorporates managed care contracting strategy and priorities with organizational strategic direction and initiatives▪ Communicates priorities and vision to operational and clinical leadership▪ Coordinates with strategic pricing and price transparency efforts, including modeling and assessment of impacts to pricing on anticipated net revenue▪ Works with operating budget team to develop revenue forecast▪ Assists in development of assumptions for the annual operating budget and the Long-Range Financial Plan.Collaborates with various other departments regarding strategy, business development, and operational objectives:▪ Assists in the assessment of demand for hospital and professional services by major payer, geographic market, clinical service line, etc.▪ Acts as a liaison in developing strong interdepartmental working relationships with senior management, department administrators, physicians, etc., for designated service line(s) regarding managed care strategy, contracting and operational issues.▪ Works with clinical operation leaders, senior management and service line administrators to identify programs to market, participates in program development and identifies opportunities to improve competitiveness of existing programs.▪ Performs special projects as assigned.REQUIREMENTSRequired Education: Bachelor's Degree in Business Administration, Hospital Administration, or related fieldPreferred Education: Master's Degree in Business Administration, Hospital Administration or related field.Required Experience: Ten years of experience as a leader in health plan strategy or related experience in the health care industry. A track record of successful leadership experience in health insurance, managed care contracting and reimbursement. Expert level knowledge of government and third-party billing regulations and guidelines. Comprehensive knowledge of contracting practices and strong understanding of health care dynamics and economics as it relates to the profitability of various services. Knowledge regarding the changing dynamics of the health care environment, particularly as it affects academic medicine, marketing, managed care strategy/contracting, managed care financial models' analysis, clinical and medical group management, and the medical reimbursement environment.It is the policy of The University of Texas MD Anderson Cancer Center to provide equal employment opportunity without regard to race, color, religion, age, national origin, sex, gender, sexual orientation, gender identity/expression, disability, protected veteran status, genetic information, or any other basis protected by institutional policy or by federal, state or local laws unless such distinction is required by law. http://www.mdanderson.org/about-us/legal-and-policy/legal-statements/eeo-affirmative-action.htmlAdditional Information

Requisition ID: 164038

Employment Status: Full-Time

Employee Status: Regular

Work Week: Days

Minimum Salary: US Dollar (USD) 0

Midpoint Salary: US Dollar (USD) 0

Maximum Salary : US Dollar (USD) 0

FLSA: exempt and not eligible for overtime pay

Fund Type: Hard

Work Location: Hybrid Onsite/Remote

Relocation Assistance Available?: Yes


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