VP Pricing Strategy (HIRED)
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Novant Health Business Development & Sales develops strategies, negotiates and maintains over $4B annual operating revenue from commercial, Medicare, Medicaid and Medicare Advantage contracts across all Novant Health markets. The current portfolio of value-based arrangements include virtually every form of payment arrangement from shared savings to full risk, including a large and growing episode strategy. The VP will also be involved in a growing portfolio of strategic business relationship strategies and transactions including potential joint venture plan and provider discussions. Business Development & Sales is responsible for all pricing strategy decisions including more than 15 facility charge masters covering every billable item at Novant Health. The department also assists Novant Health’s Medical Group in the development of pricing strategy and collaborates with Marketing and Revenue Cycle teams to lead the transition to value based care. Value based care encompasses but is not limited to risk-based contracting, performance and quality program design as well as episode development and associated gainsharing.
Business Development & Sales responsibilities are constantly evolving and currently represent key components of Novant Health’s strategic imperatives. The department consists of 2 teams: payer relationship management and pricing strategy and analytics. The Vice President of Pricing Strategy’s team is responsible for pricing strategy and modeling of Novant Health’s payer/provider contracts, all wholesale and retail pricing decisions, and all other corporate pricing efforts including understanding of healthcare expense risk for populations, its components and drivers.
The Vice President of Pricing Strategy will provide innovative, influential leadership in developing, evaluating and implementing pricing strategies and tactics for markets, facilities, services and payers across Novant Health. Collaboration with other teams across the system is extremely important.
Projects and responsibilities include:
Develop, champion, implement and monitor value-driven, competitive pricing strategies across our entire portfolio of multiple and diverse services and markets, including:
• Risk and fee-for-service arrangements for facility, physician and ancillary agreements with third party payers, both wholesale and retail.
• A strategic framework for Novant Health’s charges.
• Strategic tools and analyses to monitor and recommend consumer-driven pricing strategies and Novant Health competitive market position.
Establish and maintain market and pricing intelligence capabilities to inform and influence pricing strategy decisions, including:
• Patient focused pricing oriented market research (e.g. establishing demand curves and price elasticity’s via methodologies such as conjoint analysis).
• Competitive price intelligence for existing and potential services (e.g. purchased data, mystery shopping, web sites, etc).
• Develop, evaluate and monitor managed care revenue, risk and operating budgets, including pro-formas for existing and future business development initiatives.
• Establish, direct, and monitor system and Novant portfolio, pricing strategy and structure in coordination with Corporate Finance, clinically integrated network(s) and Novant Health Medical Group.
• Evaluate and develop strategies regarding emerging government payment programs such as Episode Payment Models, MACRA and DSRIP programs in future Medicaid arrangements.
• Develop and present pricing recommendations, outcomes and methodologies to department, internal committees and Boards.
• Inform and educate Service/Product Line leaders with respect to pricing strategies and pricing performance.
• Direct departmental financial resources which will perform financial analysis for NHI and its affiliates, coordinate with corporate finance and maximize capabilities of IT systems.
• Develop, recommend and direct methods to improve financial & market analysis, analysis of risk and reward, system and market specific pricing, financial projections and performance monitoring of regional contracts and the managed care portfolio.
• In coordination with Corporate Finance and IT, develop, implement, and monitor standardized and ad hoc yield tracking and receivables monitoring capabilities which will track and administer contractual performance and business activity supporting the ability to maximize the account management structure, system revenue, growth and retention.
• Monitor and audit risk pools and all aspects of payer reporting.
• Evaluate and monitor external market segments to develop and recommend competitive and profitable financial structures of new and existing contracts.
• Demonstrate and incorporate strategic intelligence into all aspects of work.
• Oversee analysis of risk and non-risk contractual arrangements (including reimbursement and contractual language) between owned and affiliated hospitals, ancillaries, Physicians (medical groups) and third party payers for the provision of health care services to member/patients. Payers include Commercial Insurance, Medicare Managed Care, Medicare, Medicaid Managed Care, Third Party Administrators, Workers Compensation and Employers under Direct Contracts.
• Maintains professional affiliations and participates in community, industry and professional associations to represent Novant Health within its regions.
• Performs personnel management functions including hiring, training, performance evaluation, terminations and related activities for staff.
• Integrates the Novant Health, Inc., corporate philosophies, operations and strategies, as well as its respective partnerships, affiliations, PHO’s and IPA’s into departmental objectives and operations.
• Manages multiple projects across the region and system, often by use of influence rather than authority; establishes and organizes priorities and process; executes or facilitates execution to closure within aggressive time lines.
• Develops a strong team player environment, prompts open effective communication and constructively resolves internal and external conflicts.
This position requires a wide range of financial expertise and experience in both the provider and insurance aspects of healthcare pricing and managed care as well as a high degree of familiarity with local and regional markets. The VP must be firm but collaborative while working with other stakeholders throughout the Novant Health system. They must also have a demonstrated ability to lead teams of Directors and analysts while maintaining a high level of employee engagement and satisfaction. The Vice President of Pricing Strategy continually studies and explores evolving pricing strategies, methodologies and tools, across healthcare and other industries, incorporating into Novant Health’s strategy and applicable initiatives. The Vice President of Pricing Strategy works closely with other corporate functions, including but not limited to: Novant Health Medical Group, Marketing, Finance, Consumer Strategy and Revenue Cycle, to provide sound strategic and tactical recommendations for a variety of Novant Health initiatives.
Novant Health is reinventing the healthcare experience to be simpler, more convenient and more affordable, so that consumers can focus on getting better and staying healthy. The Vice President of Pricing Strategy will strive to fulfill this promise every day.
• Education: Master’s degree required. Master Degree in Economics, Accounting, Finance, Health Care. Administration or equivalent work experience.
• Experience: Minimum ten years’ experience in health care financial management with emphasis in pricing, managed care and risk contracting.
• Additional skills required: Thorough knowledge of pricing, risk underwriting and analysis, healthcare finance, managed care and risk contracting. Considerable knowledge of alternative reimbursement methodologies across provider types and product lines. Understanding of healthcare expense risk for populations, its components (unit price and frequency), and drivers. Considerable knowledge of billing and collection process across provider types. Considerable personal computer skills including but not limited to spreadsheet and database programs. Considerable knowledge of accounting theory. Ability to manage multiple projects and meet deadlines along with flexibility in changing priorities. Presentation and communication skills required. Analytical and problem solving required. Ability to lead a strong, dynamic team and work collaboratively with Relationship Managers and Relationship Management Vice President.