Synapse Health · 2 days ago
Vice President, DME/HME Payor Engagement
United States
Full-time
Remote
Director/Executive
7+ years exp
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Responsibilities
Leads Synapse Health’s value based contracting and payor relations strategy, through participation in business development efforts and evaluation of payor density within service area(s), and expansion of payor contracts to new product lines based on expanding licensure and performance.
Lead Synapse Health’s payor partnerships by serving as the main point contact for coordination of escalation for any payor inquiries, issues, and responsibility for owning resolutions.
Responsible for managing the facilitation of quarterly joint operating committee to review payor performance (P&L, operations, customer satisfaction, etc.).
Develops and implements strategies to optimize payor contracts and improve the reimbursement process, including identifying opportunities for new payor agreements and renegotiating existing contracts to enhance terms.
Responsible for the initiation, development, negotiation, and monitoring of payor and health plan contracts, inclusive of monitoring payor specific requirements, while maintaining and continually developing contractual relationships.
Maintains up-to-date competitive information, including network participation, network reimbursement, provider incentive arrangements, medical and utilization management practices,
Foster deep relationships/partnerships with key network/payor and critical third-party decision makers.
Maintain ongoing relationships with networks/payors while identifying new contacts to expand and enhance existing relationships.
Oversees the financial performance of managed care contracts, including revenue forecasting, reimbursement optimization, and risk management.
Analyzes the market in terms of coverage and reimbursement, existing and emerging payer and healthcare regulatory policies, formulary listings, competitive landscape, trends, pricing, contracting strategies, potential barriers to provider and patient access.
Partners with various departments, including revenue cycle, legal, and finance, to ensure a coordinated approach to payor relations and dispute resolution.
Completes other projects and duties as assigned.
Qualification
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Required
At least 7-10 years of experience in the healthcare or durable medical equipment (DME) industry in payor engagement, payor relations, or value based contracting setting or other related experience.
Experience in the HME, Home-Health or related industries.
Knowledge of DME management, fulfillment, service level agreements, and systems operations.
Knowledge of commercial, Medicare/Medicaid claims processing guidelines and benefits authorization process.
Knowledge of medical coding/billing including ICD-10, CPT, CMS-1500, UB-04 etc.
Proficient in MS Office applications and ability to learn department and job-specific software systems.
Demonstrate organizational skills.
Demonstrate effective verbal and written communication skills.
Demonstrate analytical skills when problem-solving.
Demonstrate high attention to detail and a high degree of accuracy.
Preferred
Management & Leadership: Demonstrates the ability to influence and guide members of an organization.
Problem Solving: Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully.
Customer Service: Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments.
Oral Communication: Speaks clearly and persuasively in positive or negative situations; Listens and gets clarification; Responds well to questions; Participates in meetings.
Teamwork: Balances team and individual responsibilities; Exhibits objectivity and openness to others' views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Able to build morale and group commitments to goals and objectives; Supports everyone's efforts to succeed; Recognizes accomplishments of other team members.
Quality: Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality.
Benefits
Professional growth opportunities with compelling career paths
Healthy work-life balance culture with paid time off (PTO)
Medical, dental and vision insurance for full-time team members
401K savings plan with employer contribution match
Company
Synapse Health
Synapse Health is on a mission to transform the DME industry with innovative solutions that improve experience, accountability and transparency for all.
51-200 employees
Funding
Current Stage
Growth StageLeadership Team
Anthony Kilgore
Chief Executive Officer
Andrew Hayek
Co-Founder & Chairman
Company data provided by crunchbase
