Vice President of Payor Contracting - Kettering Health

Overview

Kettering Health is a not-for-profit system of 13 medical centers and more than 120 outpatient facilities serving southwest Ohio. We are committed to transforming the health care experience with high-quality care for every stage of life. Our service-oriented mission is in action every day, whether it’s by providing care in our facilities, training the next generation of health care professionals, or serving others through international outreach.

Department Overview

The Vice President of Payor Relations is responsible for leading the network’s third-party payer contracting activities and negotiation strategies, and revenue recovery activities. Responsible for the development and contracting of strategies and activities with third-party payers, employers, medical service organizations and risk entities including developing and implementing contracts and strategies for Kettering Health’s acute care hospitals, ancillaries, ambulatory surgery centers, home health,  DME, behavioral services , physician medical services and value based risk contracting for Kettering Health hospitals, Kettering Health Medical Group and Kettering Health Physician Partners. Responsible for all Charge Master activities interacting with hospital and physician for Kettering Health.  Build charge pricing, and charge pricing strategies for hospitals, drugs, institutional direct to employer services, outpatient services and physician that support the long-term pricing strategy for Kettering Health.

The Payor Relations, Contract Management division is responsible for the contract loading, maintaining and contract compliance of all third-party, government and medical contract related to Kettering Health and Charge Master and Contract Management team use reporting, maintain software system to ensure integrity of expected reimbursement system, charge detail, and generating detailed and comprehensive analysis reports as requested.  The Vice President leads staff in setting priorities, and developing and implementing strategies relative to the identification, management, and resolution of operational and administrative issue resolution with Payors and plans. In addition, active in the leadership in developing network strategies around healthcare reform, Kettering Health employee health plan, policies, reimbursement implications, innovation relative to network strategies, initiatives for healthcare integration, Payor Plans, local employers and with KH’s clinical integration network (CIN) and/or other affiliated healthcare delivery system providers.

Responsibilities & Requirements

Skills

Thorough understanding of managed care insurance industry and products, the Medicare and Medicaid programs and their financial impacts on providers.

• Skills in problem solving, financial analytics, negotiation and conflict resolution
• Excellent verbal, written communication, project management and presentation skills.
• Thorough understanding of healthcare payer market and reimbursement systems.
• Thorough knowledge and understanding of federal, state, and commercial payer organizations, including knowledge and/or experience in hospital and/or physician enterprises and payer organizations.
• Knowledge of trends and potential changes within the managed care industry
• Strong computer skills, particularly with spread sheet, word processing and presentation software
• Able to set and attain goals without direct continuous oversight management
• Maintain strong relationships with payers to facilitate and expedite revenue flow into health system.
• Exhibits Kettering Health’s Behavior Standards including, but not limited to, friendliness and courtesy, effective communication, creates a professional environment and provides first class service.

Trustworthy:

• Ability to exert strong leadership. Superior professional judgement that commands the respect and confidence of associates. Fair mindedness and ability to balance individual program priorities assuring that the overall objectives of Kettering Health are advanced.
• Responsible for overseeing the contract loading, modeling, evaluating and performance of expected reimbursement for KH and the underpayment team. Provides support to Revenue Cycle for the denial and underpayment reports and elements of Joint Operating Committee meetings and structures.

Innovative

• Provides strategy and leadership in the development of and execution of network strategies related to Payor Relations negotiations with third-party payers for KH hospitals, surgery centers, home health, DME, ancillary entities, employed physicians and aligned physician practices.
• Leads the strategy and implementation of healthcare reform, third-party payors, direct to employers, and commercial plan payers regarding payment innovation.

Caring

• Provides an environment for subordinates that is professionally stimulating, challenging, and motivating with opportunity for their personal growth and development.
• Provides a Physician friendly environment that enhances long term partnerships.
• Communicates effectively with people of varying cultures, diverse needs, and ages.
• Promotes workforce engagement to support employees, physicians, and volunteers.

Competent

• Leads staff in the administration and management of KH’s Clinical Integration Network named Kettering Health Physician Partners (KHPP)
• Responsible for the consultation, evaluation, education to all areas within KH, employed physician practice, affiliated entities and the Medical Staff and their offices on payer contracts/requirements to ensure contract reimbursement is obtained.
• Oversees all Payor Relation contracts for Kettering Health.

Collaborative

• Leads the team who manages the payer Joint Operating Committees with adequate resolution of issues on behalf of Kettering Health’s best interests.
• Interfaces with Hospital Presidents, Executive Leaders, VP of Revenue Cycle, Chief Financial Officers, Physician leaders, Service line Directors, Ohio Hospital Association and other varies hospital and physician executives to assure all Payor Relation and payment innovation activities are communicated, performed, and executed timely with strategic execution in the best interests of Kettering Health.

Preferred Qualifications

Bachelor’s degree required; master’s degree in business administration or Certified Public Account designation preferred.

Ten or more years of progressively challenging experience in managed care in healthcare provider or payer sites, and preferably both.

Professional Affiliations

Membership in the American College of Healthcare Executives (ACHE) and other appropriate professional organizations is considered a helpful element of this position.  Participation in community organizations which will enhance the effectiveness of the incumbent, or the hospital is encouraged.