VP, Sales – Risk & Quality

Job not on LinkedIn

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $233k - $254k / year

⏰ Full Time

🔴 Lead

🎲 Risk

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HealthEdge

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2005

🏥 Healthcare

💼 Consulting

⚕️ Healthcare Insurance

Healthcare • Consulting • Healthcare Insurance

HealthEdge is a company that specializes in providing advanced solutions for healthcare payers through its HealthRules Solutions Suite. This suite includes a comprehensive digital claims administration processing system, care management workflow solutions, and payment integrity solutions, which aim to enhance operational efficiency and improve quality of care for health plans. By leveraging integrated technology and automation, HealthEdge helps health plans eliminate data silos, increase payment accuracy, and elevate member experience, thereby transforming the healthcare landscape for better collaboration and accessibility.

📋 Description

• Help sales and CSEs build and maintain relationships with key decision-makers • Understand client needs and align current and future solutions with strategic goals • Assist in developing and executing market-specific sales plans using market insights and competitive intelligence • Work with Sales and Marketing to design and implement strategic direction for top prospects • Partner with Sales Operations, Product, Technology, Marketing, and Client Services to identify, scope, and determine key prospects • Drive new business and expand existing accounts to increase annual recurring revenue • Sell Risk Adjustment and Quality solutions, including retrospective and prospective Risk Adjustment offerings, STAR ratings, HEDIS, and quality improvement solutions • Execute the sales process by analyzing client workflows, matching needs to solutions, conducting presentations and demonstrations, negotiating pricing and contracts, closing sales, and updating the CRM • Help identify, qualify, and pursue new business opportunities and maintain a healthy sales pipeline • Engage management and executive-level prospects, build relationships, network with associations, and provide solution demonstrations • Assist with RFI/RFP responses and coordinate with internal product experts • Collaborate cross-functionally to support onboarding and long-term client satisfaction • Monitor industry trends, customer challenges, CMS regulatory developments, ODAG/HPMS reporting requirements, and risk adjustment coding trends • Provide pipeline forecasts, status updates, activity reports, and risk insights to sales leadership and teams

🎯 Requirements

• 15+ years of experience in Risk Adjustment, Stars, HEDIS, and Quality Solutions, preferably in healthcare SaaS/BPaaS or enterprise software solutions • Demonstrated knowledge of Medicare Advantage, ACA, and/or Managed Medicaid Risk Adjustment strategies, including retrospective and prospective coding programs • Experience selling or positioning quality improvement solutions tied to CMS requirements, including STAR ratings and HEDIS • Healthcare subject matter expertise and solid technical knowledge/aptitude with enterprise-class insurance transaction and healthcare management information systems • Knowledge and experience with the HealthEdge product suite is a plus • Understanding of BPaaS and SaaS delivery models as applied to risk adjustment outsourcing, with experience addressing health plan build vs. buy considerations • Proven track record of meeting or exceeding sales targets, with experience managing complex, multi-stakeholder sales processes • Strong knowledge of the healthcare industry, particularly payer/provider dynamics, risk adjustment, and value-based care • Excellent presentation, communication, and interpersonal skills • Exceptional verbal and written communication skills, with the ability to convey complex technical concepts to non-technical audiences • Strong analytical and problem-solving abilities • Ability to work independently and travel as needed within the assigned territory • Ability to work across multiple time zones in a hybrid or remote work environment • Candidates may be required to undergo a pre-employment criminal background check

🏖️ Benefits

• Equal opportunity employer committed to workforce diversity • Reasonable accommodations for individuals with disabilities • Remote or hybrid work environment • Travel as needed within the assigned territory • Pre-employment criminal background check