VP Payer Relations & Clearinghouse Operations

ABOUT THIS POSITION

Waystar provides cloud-based technology that simplifies and unifies healthcare payments. Together, our technology, data and client support streamline workflows and improve financials for our clients, so that they can focus on their patients. We are deeply committed to living out our organizational values: honesty; kindness; passion; curiosity; fanatical focus; best work, always; making it happen; and joyful, optimistic, and fun.

WHAT YOU'LL DO

What is the purpose of this position?

The Vice President of Payer Relations is responsible for initiatives to create innovative and transformative payer strategies, relationships, and agreements. As a key member of the management team, the VP Payer Relations will drive new value for Waystar’s clients by unlocking new partnerships and capabilities with Insurance Carriers, help improve Waystar’s outcomes and lower costs by using APIs to effectively exchange data with payers, build and sustain high-value networks and create collaborative partnerships with payers. This role positions the organization for sustainable financial performance through sophisticated and innovative payer strategies. This role will report to the EVP, Digital information & Cyber Security officer.

Key Responsibilities:

• Operational Management:
  • Oversee the entire clearinghouse operation, including EDI and API data exchange related to the revenue cycle.
  • Ensure adherence to industry standards and regulatory requirements, such as HIPAA and CMS regulations.
  • Monitor key performance indicators (KPIs) to measure efficiency and identify areas for improvement.
  • Implement and maintain quality control measures to minimize errors and ensure accuracy.
  • Manage staff and resources to ensure optimal productivity and efficiency.
• Payer Relationship Management:
  • Develop and maintain strong relationships with payers, including health insurance companies, managed care organizations, and government agencies.
  • Create new, mutually beneficial data exchanges that drive value for providers and health insurance companies.
  • Negotiate contracts and agreements with payers to ensure favorable terms and conditions.
  • Resolve disputes and claims denials with payers promptly and effectively.
  • Stay informed about payer policy and procedure changes and implement necessary adjustments.
• Technology and Systems:
  • Select, implement, and manage the clearinghouse's technology infrastructure, including software and hardware.
  • Ensure the security and integrity of patient data and other sensitive information.
  • Stay updated on industry trends and technologies and explore opportunities for innovation.
• Financial Management:
  • Develop and manage the clearinghouse's budget.

• Identify cost-saving opportunities and implement strategies to improve financial performance.

OPTIONAL DETAILS --Looking for some details?

• Assume leadership in developing, executing, and managing the company’s overall payer strategy to transition to highly effective, secure, and reliable payer connectivity.
• Develop strategies to advance payer partnerships and overall efforts to maximize the value of strategic payer partnerships for the organization.
• Apply financial and analytic acumen to achieve desired outcomes.
• Maintain close working relationships with payers, including joint contracting, planning, and joint ventures.
• Work with management to ensure the staff is appropriately trained to maintain the highest effectiveness and efficiency.
• Ensures regional compliance with local, state, and federal regulations and standards.
• Is an active member of the technology executive leadership team and promotes system-wide strategies?
• In conjunction with peer executives, service line directors, and finance team members, prepare operating and capital budgets to ensure that the appropriate resources are allocated and invested to meet the delivery needs for assigned business unit.
• Leads the development of key performance indicators, reporting of such and the development of management systems to ensure achievement of such KPIs for business units.
• Responsible for ensuring that established financial and quality goals are achieved.
• Participates in the formulation and/or update of the business unit operations and annual strategic plan.
• Directs the formulation and/or update of the annual strategic plans for assigned business unit to fulfill the goals and objectives of the systems strategic plan.
• Maintains productive working relationships.
• Provides the leadership necessary to ensure the business unit is responsive to the continuing healthcare needs of the communities it serves.
• Provides leadership in corporate-sponsored project teams to achieve continuity in the system-wide care continuum and supports performance improvement efforts at the business unit.

Do you fit our team?

• 10+ years industry experience with progressive leadership responsibility and experience in healthcare organizations
• 5+ years partnering with payers to deliver innovative healthcare information technology solutions to deliver meaningful outcomes.
• Must demonstrate a track record of being an accomplished executive, ideally with healthcare system experience.
• Extensive strategic planning and budget formulation skills at an executive level with complex analytical and problem-solving skills.
• Must possess strong leadership skills and be an effective team builder.
• Dedication to excellence and innovation regarding continuous quality improvement, patient care models and clinical integration.
• Knowledge and understanding of the driving forces in the local, state, and national healthcare markets and the ability to assess emerging trends and needs and develop plans to address such trends.
• A demonstrated record of and concern for positive employee relations.
• Must possess excellent written, verbal and listening communication skills and be comfortable and effective in working with all levels of management, Board, employees, physicians, the community, and donors.
• Must evidence a commitment to continuing professional development.

WHAT YOU'LL NEED

Preferred Skills:

• Master's Degree in a related field or an equivalent combination of education and experience.
• Experience with electronic health records (EHRs) and other healthcare technology platforms.
• Knowledge of coding and billing practices.
• Experience with revenue cycle management including payer relationships.

WAYSTAR PERKS

• Competitive total rewards (base salary + bonus, if applicable)
• Customizable benefits package (3 medical plans with Health Saving Account company match)
• Generous paid time off starting at 3 weeks + 13 paid holidays including 2 personal floating holidays
• Paid parental leave (including maternity + paternity leave)
• Education assistance opportunities and free LinkedIn Learning access
• Free mental health and family planning programs, including adoption assistance and fertility support
• 401(K) program with company match
• Pet insurance
• Employee resource groups

Waystar is proud to be an equal opportunity workplace. We celebrate, value, and support diversity and inclusion. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, marital status, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

This applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.