Payor Contracting & Credentialing Manager
knownwell
Remote
Posted on Sep 12, 2024
Meet knownwell, weight-inclusive healthcare for all. Join a dynamic company that is changing the way care is delivered to patients with obesity. knownwell is a weight-inclusive healthcare company offering metabolic health services, primary care, nutrition counseling and behavioral health services for anyone of any size. Our hybrid model allows for both in-clinic and virtual care to bring support to patients where and when they need it. To learn more about our recent Series A funding, led by Andreessen Horowitz, please check out this article.
To achieve our ambitious goals, we're looking for a Payor Contracting and Credentialing Manager to join our Growth team. This role will play a critical role in building, shaping and scaling our network so that all Americans have coverage to get services from knownwell. This person will take point on all things payor at knownwell and they will be responsible for all payor contracting and credentialing. As part of the role, they will directly negotiate new contracts and renewals as well as manage credentialing for all providers.
The candidate that will achieve the greatest success will be a seasoned managed care leader, who understands payor strategies and has a successful track record in negotiating strong contract rates year-over-year across a number of geographies. Knownwell is seeking a top-flight contracting and credentialing leader who is respected by payors, is strategic in outlook, and is a master at the art of negotiation.
Responsibilities:
- Represent knownwell in developing, evaluating, and implementing strategies for payer and Managed Care Organization (MCO) relationships to achieve knownwell objectives, including for Commercial, Medicare Advantage, and Managed Medicaid plans
- Own the end-to-end contracting process including initial outreach, pitching, negotiation, execution, go-live, relationship management and renewal
- Negotiate competitive contract terms
- Actively manage contract portfolio owning the payor relationships including an engagement plan with stakeholder identification and engagement, escalation and appropriate use of JOCs
- Develop strategic payor relationships to drive better economics as well as other goals such as service line expansion, member growth and retention
- Put in place systems and processes for tracking pipeline, contract management, renewals, rate analysis and ongoing performance of contracts
- Develop standardized contract language terms and acceptable payment rates that are consistent with knownwell financial and legal guidelines and goals
- Manage the development of databases and analytical tools to assist in the negotiation of contracts and the tracking, analysis, and reporting of contract performance.
- Create a targeting strategy to prioritize which payors to dedicate resources towards, on a state by state basis
- Partnering closely with operations, legal, and clinical teams
- Serve as organization-wide subject matter expert on health plans and other risk-bearing entities in healthcare
- Develop a people strategy for Payor Partnerships, design the org chart, develop candidate profile and recruit team members
- Lead team to achieve ambitious targets
- Analyzes and reports contract performance and industry trends to senior management
- Develop Value Based Care (VBC) strategy aligned with company goals and capabilities and execute VBC contracts
Qualifications:
- 7-10+ years of payor contracting experience
- Experience working at a provider with multi state coverage responsibilities, ideally national
- Experience working at a payor, consulting firm, or healthcare technology provider
- Experience working at fast paced organizations, ideally technology startups
- Management experience building and leading a team
About You:
- Ability to create a strategic vision for the team, leadership skills, persuasiveness in presenting and selling managed care strategies and tactics, sensitivity to the expectations of the various constituencies
- You think systemically, project manage efficiently, and communicate with a level of context, sophistication, and analysis that drives great cross-functional work
- Knowledge regarding the changing dynamics of the healthcare environment
- Care about people you work with and take an interest in them
- Inspiring leader who catalyzes high levels of performance and growth on their team
- Obsessed with the business of healthcare and building things while not being afraid to get your hands dirty
- You’re scrappy and a quick learner
- Strong ability to quickly make decisions despite ambiguity
- Ability to move quickly to get stuff done
We offer a competitive salary, comprehensive benefits package, and the opportunity to be part of a purpose-driven organization that is dedicated to making a positive impact on the lives of patients. If you are an ambitious and experienced design leader who is passionate about transforming healthcare and creating meaningful change, we invite you to apply and join our dynamic team.
knownwell, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.