Payer Contracting Director

Company Description

Privia Health™ is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices, improve patient experiences, and reward doctors for delivering high-value care in both in-person and virtual settings. The Privia Platform is led by top industry talent and exceptional physician leadership, and consists of scalable operations and end-to-end, cloud-based technology that reduces unnecessary healthcare costs, achieves better outcomes, and improves the health of patients and the well-being of providers.

Job Description

The Payer Contracting Director works directly with market leaders through development, evaluation, negotiation and maintenance of Privia’s value based contracts with payers and potentially with other providers. This role provides leadership in contracts administration and as a representative of Privia Medical Group (PMG) with payers in the group’s market areas.

Primary Job Duties: 

• Manage cross functional work-streams across a variety of teams, including Payer Contracting, Population Health Management, Performance Management, and Analytics
• Manage strategic relationships with payers
• Manage difficult strategic issues with Payer Contracting and Population Health Leadership
• Makes strategic recommendations based on assessment of market opportunities
• Responsible for assessing legal and financial implications of all contracting opportunities, including new contacts, contractual amendments and assignments to existing contracts
• Represents Privia Medical Group to third party payors
• Works with Legal, Finance, Revenue Cycle Management, and other teams to develop workable business arrangements that are consistent with Privia’s contracting goals
• Assists in development of policies and procedures for contracting which meet the market demands and which are consistent with the needs of Privia Medical Group stakeholders
• Collaborate with internal stakeholders to develop financial analytics, financial impact scenarios and profitability metrics as a key element in the contract proposal process
• Monitor contract performance and help develop tactics for remediation of under-performing contracts
• Responsible for managing contract development process on behalf of Privia Medical Group providers, including contract proposals, preparation of contracts for contract language, value based and shared/full risk payment programs, following all internal controls for contract review, approval and signature in alignment with Privia’s vision, goals and objectives
• Ability to personally gain access to key payer decision makers for targets in geography of responsibility
• Analyze and estimate financial impact of managed care contracts as requested by senior leadership
• Some travel is required
• Perform other duties as assigned

Qualifications

• Bachelor’s degree preferred. Healthcare Master’s or MBA highly preferred.
• 6+ years of experience working in health plans, health systems, or provider organizations; 
• Thorough understanding of managed care insurance products and their financial impacts on payers and providers; understanding of contracting processes and operations required
• Must be able to effectively function in high-level negotiation activities and possess strong negotiating skills 
• Able to grasp both clinical and business concepts
• Strong analytical skills; Quantitative, and financially focused
• Project manager able to juggle multiple projects and urgent deliverables 
• Strategic and flexible thinker who assesses situations carefully and delivers scalable recommendations and results
• Must comply with all HIPAA rules and regulations

The salary range for this role is $125,000 to $150,000 in base pay and exclusive of any bonuses or benefits (medical, dental, vision, life, and pet insurance, 401K, paid time off, and other wellness programs). This role is also eligible for an annual bonus targeted at 15% & restricted stock units. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location.

Additional Information

All your information will be kept confidential according to EEO guidelines.

Technical Requirements (for remote workers only, not applicable for onsite/in office work):

In order to successfully work remotely, supporting our patients and providers, we require a minimum of 5 MBPS for Download Speed and 3 MBPS for the Upload Speed. This should be acquired prior to the start of your employment. The best measure of your internet speed is to use online speed tests like https://www.speedtest.net/. This gives you an update as to how fast data transfer is with your internet connection and if it meets the minimum speed requirements. Work with your internet provider if you have questions about your connection. Employees who regularly work from home offices are eligible for expense reimbursement to offset this cost.

Privia Health is committed to creating and fostering a work environment that allows and encourages you to bring your whole self to work. Privia is a better company when our people are a reflection of the communities that we serve. Our goal is to encourage people to pursue all opportunities regardless of their age, color, national origin, physical or mental (dis)ability, race, religion, gender, sex, gender identity and/or expression, marital status, veteran status, or any other characteristic protected by federal, state or local law.