SVP, Payor Strategy

Job not on LinkedIn

🔥 41 minutes ago

🇺🇸 United States – Remote

💵 $240k - $330k / year

⏰ Full Time

🔴 Lead

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Axia Women's Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2017

🏥 Healthcare

👥 B2C

🧘 Wellness

💰 Private equity on 2017-03

Healthcare • B2C • Wellness

Axia Women's Health is a leading women’s health network that provides comprehensive, personalized obstetrics and gynecology care across every stage of life. The organization offers a wide range of clinical services—including obstetrics, gynecology, maternal-fetal medicine, breast health and imaging, fertility and genetics, urogynecology, menopause care, behavioral health, and telehealth—through a connected network of specialists and on-site diagnostics. Axia emphasizes compassionate, patient-centered care, integrates innovative technologies (such as AI-assisted mammography and virtual visits), and focuses on improving the overall care experience for women.

📋 Description

• Develop and execute a multi-year payor strategy across commercial, Medicare Advantage, and Medicaid managed care plans • Lead contracting on behalf of affiliated professional corporations within the MSO model • Assess market dynamics, payor behavior, and competitive positioning to set contracting priorities • Lead negotiations, renewals, and amendments of fee-for-service agreements • Improve rates, strengthen contract terms, and reduce administrative burden • Build contract strategies for professional, imaging, and laboratory fee schedules • Address prior authorization, site-of-service, and ancillary billing terms • Manage escalations, disputes, and termination strategy • Monitor contract compliance, identify underpayments, and reduce reimbursement leakage with Revenue Cycle and Finance • Design, negotiate, and expand value-based care arrangements and alternative payment models • Model financial and operational impact of proposed arrangements and recommend structures • Track quality, utilization, and cost benchmarks and capture earned incentives • Structure payor arrangements for new markets and service lines • Build relationships with health plan leadership in current and expansion markets • Lead payor diligence for prospective practice acquisitions and affiliations • Review contracts, rate benchmarks, assignment and change-of-control provisions, and reimbursement risks • Guide payor onboarding of newly affiliated practices • Provide reimbursement assumptions and synergy estimates for deal modeling and integration planning • Maintain payor performance scorecards covering rates, contract profitability, VBC performance, and denial trends • Present findings and recommendations to the Chief Growth Officer, executive leadership, physician leadership, and the Board • Monitor federal and state reimbursement policy, CMS rulemaking, and payor policy changes • Advise on business implications • Manage a small team supporting contracting and payor analytics • Report to the Chief Growth Officer and serve as a strategic advisor to executive leadership, Finance, Revenue Cycle, Operations, and physician leaders

🎯 Requirements

• Bachelor's degree required • 12+ years of payor contracting, managed care, or reimbursement strategy experience, with significant provider-side experience • Experience contracting for a multi-site physician group, MSO, practice management organization, or ambulatory provider platform • Proven record of leading complex, multi-payor negotiations at the executive level • Expert command of commercial, Medicare Advantage, and Medicaid managed care contracting and reimbursement methodologies • Proven leadership ability, including building, developing, and holding accountable a lean, high-performing team • Demonstrated success negotiating FFS rate improvements and VBC arrangements for provider organizations • Strong financial modeling and analytical skills • Thorough understanding of MSO and PC structures, including payor contracting within them • Working knowledge of revenue cycle, credentialing, and physician practice operations as they relate to reimbursement performance • Executive presence and strong relationship skills with health plan leadership, physicians, and deal teams • Ability to work independently and deliver results in a fast-growing, private equity-backed environment • Experience in an MSO or private equity-backed physician practice management environment strongly preferred • Experience supporting M&A diligence and post-close integration of physician practices preferred • Payor contracting experience and established health plan relationships in New Jersey, Pennsylvania, Indiana, and/or Kentucky preferred • Experience in women's health or related specialties preferred • Payor-side experience in network management or provider contracting preferred • MBA, MHA, MPH, JD, or related advanced degree preferred • Applicants must be currently authorized to work in the United States on a full-time basis • Must complete employment eligibility verification upon hire

🏖️ Benefits

• 401(k) with company match • Generous PTO offering with additional time off for volunteering • Multiple medical insurance plans • Access to Axia providers at little to no cost through Axia’s medical insurance • Axia-paid life insurance • Short-term and long-term disability insurance • Free counseling for colleagues and family members, including parents and parents-in-law • Discounts on hotels, theme parks, gym memberships, and more through the Great Works Perks Program • Dental insurance • Vision insurance • Supplemental life insurance • FSA • HSA with employer contribution • Identity theft insurance • Long-term care insurance • Pet insurance