Director, Alternative Payment Model Performance

Job Summary

The Senior Director, Finance Vendor Governance is responsible for executing a comprehensive financial vendor strategy at the enterprise/market level. This role includes , but is not limited to, designing, developing, negotiating, implementing, administering, and overseeing the financial components of vendor contracts providing medical or medical administrative services and their claims, capitation and/or administration costs are reported to the state, vendors or providers with shared savings arrangements, vendors providing supplemental benefits, and those vendors that have administration costs tied to quality reclass.

Essential Functions

• Oversee vendor contracts for medical or medical administrative services where their claims, capitation and/or administration costs are reported to the state, vendors with shared savings arrangements, vendors providing supplemental benefits, and those vendors that have administration costs tied to quality reclass in collaboration with the IT, Claims and Operations teams that ensure the contract operational components are administered correctly.
• Develop and manage policies and procedures for administering and managing vendor contracts including payments, reconciliation, invoicing, capitation payments, and shared savings arrangements.
• Drive strategy with corporate and market partners in vendor contract negotiations supporting development of the financial components of the contract, ensuring vendor payments meet MLR reporting and rate development requirements, and establishing corporate guardrails around allowable structures.
• Develop the Finance vendor contract strategic plan including setting the strategy for Value Based Purchasing initiatives that differentiate and enable the markets to excel, assisting in setting performance metrics, ensuring ROI for the company, and achieving financial and quality targets.
• Develop and administer a strategy to ensure Accounting has the information to load contract