Vice President, Payor Engagement

Synapse Health | Who We Are

With the collective efforts of our epic team members, we’re trailblazing a new path in the DME industry. Synapse Health was founded in 2016 with a goal to fix the fractured DME ecosystem and completely transform the industry. Built on decades of industry and leadership experience, we’ve launched tech-based solutions that eliminate age-old DME headaches, resulting in a seamless experience for all. We are proud to offer work that matters, on a mission that matters.

Intrigued? Learn more at SynapseHealth.com and on Synapse Health’s LinkedIn.

What We Need

The Vice President, Payor Engagement will play a crucial role in developing and maintaining relationships with payors to ensure the successful implementation and utilization of our services. The ideal candidate will have a deep understanding of the healthcare industry, strong negotiation skills, and a proven track record of driving payor engagement and reimbursement strategies.

What You Will Do

• Leads Synapse Health’s value based contracting and payor relations strategy, through participation in business development efforts and evaluation of payor density within service area(s), and expansion of payor contracts to new product lines based on expanding licensure and performance.
• Lead Synapse Health’s payor partnerships by serving as the main point contact for coordination of escalation for any payor inquiries, issues, and responsibility for owning resolutions.
• Responsible for managing the facilitation of quarterly joint operating committee to review payor performance (P&L, operations, customer satisfaction, etc.).
• Develops and implements strategies to optimize payor contracts and improve the reimbursement process, including identifying opportunities for new payor agreements and renegotiating existing contracts to enhance terms.
• Responsible for the initiation, development, negotiation, and monitoring of payor and health plan contracts, inclusive of monitoring payor specific requirements, while maintaining and continually developing contractual relationships.
• Maintains up-to-date competitive information, including network participation, network reimbursement, provider incentive arrangements, medical and utilization management practices,
• Foster deep relationships/partnerships with key network/payor and critical third-party decision makers.
• Maintain ongoing relationships with networks/payors while identifying new contacts to expand and enhance existing relationships.
• Oversees the financial performance of managed care contracts, including revenue forecasting, reimbursement optimization, and risk management.
• Analyzes the market in terms of coverage and reimbursement, existing and emerging payer and healthcare regulatory policies, formulary listings, competitive landscape, trends, pricing, contracting strategies, potential barriers to provider and patient access.
• Partners with various departments, including revenue cycle, legal, and finance, to ensure a coordinated approach to payor relations and dispute resolution.
• Completes other projects and duties as assigned.

What You Have

• At least 7-10 years of experience in the healthcare or durable medical equipment (DME) industry in payor engagement, payor relations, or value based contracting setting or other related experience.
• Experience in the HME, Home-Health or related industries.
• Knowledge of DME management, fulfillment, service level agreements, and systems operations.
• Knowledge of commercial, Medicare/Medicaid claims processing guidelines and benefits authorization process.
• Knowledge of medical coding/billing including ICD-10, CPT, CMS-1500, UB-04 etc.
• Proficient in MS Office applications and ability to learn department and job-specific software systems.
• Demonstrate organizational skills.
• Demonstrate effective verbal and written communication skills.
• Demonstrate analytical skills when problem-solving.
• Demonstrate high attention to detail and a high degree of accuracy.

What Sets You Apart

• Management & Leadership: Demonstrates the ability to influence and guide members of an organization.
• Problem Solving: Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully.
• Customer Service: Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments.
• Oral Communication: Speaks clearly and persuasively in positive or negative situations; Listens and gets clarification; Responds well to questions; Participates in meetings.
• Teamwork: Balances team and individual responsibilities; Exhibits objectivity and openness to others' views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Able to build morale and group commitments to goals and objectives; Supports everyone's efforts to succeed; Recognizes accomplishments of other team members.
• Quality: Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality.

What Sets Us Apart

It’s no secret that most of us work to provide for ourselves and those we love, but just because we have to work, doesn’t mean we can’t enjoy it. In fact, at Synapse Health, we insist on it! We want our team members to thrive personally and professionally, which is why our benefits include:

• Professional growth opportunities with compelling career paths
• Healthy work-life balance culture with paid time off (PTO)
• Medical, dental and vision insurance for full-time team members
• 401K savings plan with employer contribution match

Synapse Health is an equal opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, national origin, disability, genetic information, pregnancy, or any other protected characteristic as outlined by federal, state, or local laws.