About the Position:
The Director of Payer Adoption will assume responsibility for developing and implementing our payer strategy associated with Durable Medical Equipment products and is aligned to our rapid growth strategy and priorities. The payer strategy includes acquisition of both direct and indirect key payer contracts in each state from commercial, and worker’s compensation payers. For optimal claims payment, these will be generated by both start-up and legacy ancillary providers including durable medical equipment, physical therapy, and physician-led entities. Partnership versus buy versus build decisions will need to be made for each entity / region.
In addition to building the portfolio of payer contracts, whether new or partnership/legacy, the candidate must also have the skillset of negotiating to achieve payment for new, pioneer products or treatments.
The ideal candidate has prior executive level ancillary operating experience at both the start-up and legacy level, and demonstrated leadership in direct and indirect payer contract acquisition and execution, for both traditional fee-for-service and other payment methods.
Key contacts within the payor network is optimal. Additionally, knowledge of payer decision-making processes, internal hierarchy, and operations and industry reimbursement trends, along with Level I and Level II HCPCS codes for traditional and alternative payment models (APM), are required to identify optimal payer targets and associated revenue forecasting for reimbursement of our products.
In addition to demonstrating exceptional analytic and sales/business development skills, integration (relative to payer strategy) to other functional areas, and collaboration on risk/reward, ROI, and time-to-market analysis, for review with executives in Commercialization, Finance, Reimbursement and Billing, Legal, Physician Management, and other areas, is required.
ESSENTIAL FUNCTIONS:
- Acquire Managed Care Ancillary contracts for National DME Provider to grow Payer portfolio on an ongoing basis.
- Serve as primary point of contact for Managed Care Payer agreements throughout management of each contract’s lifecycle.
- Track executed contract approvals, coordinate electronic signature(s), and implement final Payer agreements in conjunction with Chief Operations Officer (COO) and General Counsel approval.
- Verify that Payer contract agreements are in compliance with all state, federal, and Corporate requirements.
- Work closely with Accreditation and Compliance Manager and the Director of Revenue Cycle on special projects, analysis, and reporting.
- Serve as primary point of contact during specific contract change, renegotiation with Payers.
- Travel as needed for Payer, Partner or Orthopedic Referral source meetings or negotiations.
The Ideal Candidate has 10 years of ancillary operations experience in both start-up and legacy healthcare environment that combines rendering patient services and processing CMS1500 or UB bills for collections from federal, state, commercial and workers’ compensation payers.
Our Director of Payer Adoption position requires demonstrated success in past performance and a high level of accountability, along with the development of a plan and key milestone/deliverables within the first 30 days of employment.
We seek a candidate who can play both rapid, entrepreneurial, outside-the-box, guerrilla problem-solving (think Indiana Jones vs. the swordsman), and forward-looking enterprise-level planning. This person can find an immediate solution that enables business to be transacted today, while planning and implementing an ideal mid-term / long-term solution in the background.
Since this function will likely evolve into a small group, we will entertain strong candidates who have a subset of these qualifications to begin with the team now.
Compensation ranges depending on experience and capability, and will include base salary, bonus, and stock options (additional compensation in an IPO). We seek the right candidate and are willing to compensate correctly for an “Indiana Jones.”
If you like what you read here, are passionate, and are the kind of person who likes good news, likes to play, and wants to win, come join our family and make this your new home.
To be considered for this role, please submit a resume together with a detailed cover letter explaining how you meet the above qualifications and why you believe you’re an ideal fit. Please include information about past successes in a similar role. Applications without a detailed cover letter will not be considered.
Openness, honesty, and candor are qualities we respond to, as opposed to framing things with sophisticated or corporate words. Please be yourself and let the dice roll.
Thank you for your interest. We look forward to meeting you!