Payor Relations Manager

KONZA’s Mission:

KONZA is deeply committed to connecting health care providers, patients, health plans and our technology partners together to organize health care data into information that will drive health care transformation.

Payor Relations Manager

The Payor Relations Manager is responsible for creating new and advancing existing strategic relationships with health plans and employers that utilize clinical data. Accountable for delivering on contractual and programmatic performance metrics across all health plans (Medicare, Medicaid, Commercial, Direct to Employer). The Payor Relations Manager will oversee interactions with external payors and employers for the resolution of issues. In addition, has direct responsibility for the development and execution of strategic initiatives that advance payor market share.

The Payor Relations Manager will have direct relationships with all KHIN/KONZA teams and processes including administration, business development, customer support, business intelligence, health information exchange, and quality reporting. They will work closely with the KHIN/KONZA senior management and clinical leaders to identify, build and deliver innovative data solutions for Payors.

This individual will bring a working understanding of Alternative Payment Models, healthcare planning, payor contracting, healthcare analytics, project management, and financial principles. Lastly, they will lead all aspects of payor network strategy and will oversee the delivery of products and services to the payor.

Essential Functions:

• Establish a comprehensive Payor strategy including recruitment of new payors, contracting, and product delivery.
• Align KONZA products and services with health plan quality improvement and provider improvement.
• Support the Quality Team and pursues initiatives to ensure the integrity of the data KONZA delivers.
• Develop, implement, and maintain a data-driven state-of-the-art approach to support payors and providers in value-based payment models including data solutions for the following:
• Population risk stratification and segmentation
• Social determinants of health
• Disparities in health inequity in health outcomes and care processes
• Effective use and maximization of care integration and management processes
• Maximization of preventative and wellness opportunities
• Quality measurement and reporting
• Identify valuable data flows for existing payor solutions.
• Track and gather information around individual payor preferences and operational capabilities to support creative new data delivery solutions.
• Document and track most valuable data sources and fields to payor clients and communicate those to KONZA leadership.
• Document, track, and establish optimized payment models between payor and KONZAs developed customers.
• Using KONZAs CRM system maintain client points of contact.
• Provide strategic input into payor contracting and product deliverables.
• Provide oversight and project management for payor deliverables, contracts, and project plans.
• Implement process improvement efforts to accelerate and deliver on payor products.
• Ensure data requirements are met for required external reporting (HEDIS, Risk Adjustment, Quality Metrics, and others).
• Revise guidelines, plans, policies, and procedures to support payor programmatic, regulatory, and compliance needs.
• Educate KONZA leadership regarding contracts and the payor/employer market. Performs as institutional resource on health care payor market issues.

Characteristics and Attitudes:

• Enjoy working on difficult problems.
• Able to come up with creative solutions.
• Able to work with multiple internal teams on a variety of projects
• Able to work independently with little supervision.
• Results-oriented.
• Be 100% committed (personal growth, professional image, belief in the company, products, and clients).
• Able to remain calm in pressured situations.

Qualifications: (Knowledge, Skill, and Ability)

• Bachelor’s Degree. in business admin or healthcare administration. MBA or MHA preferred.
• Payor or managed care experience or experience contracting on the provider’s side.
• 3+ years of management or project management experience.
• Demonstrate high-level negotiation and problem-solving skills.
• Superb people manager and experience successfully managing resources and budgets.
• Substantial working knowledge of Alternative Payment Models, accountable care processes, payor contracting, and the fundamentals of clinical integration.
• Demonstrated ability to skillfully counsel, collaborate, inspire, and build confidence in others; create alliances, obtain support and respect from diverse groups and foster an understanding and commitment to the organization.
• Possess a track record of developing a good rapport with Payors, physicians, and clinical staff with the ability to grow and maintain relationships.
• Demonstrated successful project management, program development, change management, relationship building, and staff development in prior leadership roles.
• Ability to analyze and use data to influence change.
• Knowledge of payor data requirements for HEDIS, Risk Adjustment, and Alternative Payment Models such as ACOs.
• Knowledge of the health information exchange industry and clinical data structures.

The position is primarily remote with potential travel required to the Kansas City area.
To apply, complete our online application and send your resume and cover letter to HRteam@ScottHR.com.

Pay: From $73,000.00 per year