Type of Employment: Full Time
Department: Clinical Process Outsourcing (CPO)
Reports To: Chief Revenue Officer
Location: Nashville, TN OR Remote
Travel: 25-50% (Seasonal, based on account needs)
The VP of Payer Solutions is responsible for providing Shearwater with expertise and guidance around the primary Payer Vertical solutions for HEDIS, STARS and Risk Adjustment Coding services. Additionally, the VP of Payer Solutions will collaborate and support the strategy and work-plans for Shearwater to develop and deliver additional services to the Payer market, as they align with Shearwater’s clinical and operational infrastructure. This will require thought leadership and ongoing industry analysis as well as developing extraordinary rapport with Shearwater Health clients, understanding client needs, guiding go-live processes in concert with CPO leadership in the Philippines with training support when within the area of expertise, mapping of agreed client functions appropriate for Shearwater Health CPO, and supporting the Subject Matter Expert Role.
The VP of Payer Solutions will function as a Subject Matter Expert (SME) that will support the Sales, Account Management, and Operational Delivery efforts for the accounts that fall within their market expertise. They are responsible for providing insights into the delivery, facilitating the development of new/enhanced workflow or volume processes, supporting client training/onboarding, scoping SLA’s in sales process and monitoring industry level impact on our offerings in their market.
• 10+ years of Payer experience, working in a health plan in a leadership role.
• Proven experience in the successful implementation of cross-functional programs that require operational planning and oversight throughout the lifecycle of the initiative
• Extensive knowledge and experience with HEDIS, STAR and Risk Adjustment programs in a strategic and operational leadership capacity.
• Comprehensive understanding of CMS regulatory guidelines for FDR operations and oversight, including participation in the onboarding and management of FDRs within the health plan.
• Demonstrated experience with Microsoft office applications, specifically with Excel and Word.
• Adept in public speaking, critical thinking and technical writing
• A Bachelor’s Degree from an accredited college or university
• MHA or MBA preferred
• Sales and marketing background with a focus on client relationships
• Relevant clinical and operations expertise. Experience in documentation management and process mapping; Six Sigma experience preferred.
1. Assist as subject matter expert in payer and related sales/development processes for Shearwater payer services and analytics offerings such as risk adjustment, HEDIS, STARs maximization, strategic investigative services, coding, etc.
2. For new clients, serve as point on implementation planning, preparation of staff in the Philippines, and ongoing and appropriate communication with client in the United States.
3. During go-live and production, manage team leads and support staff in the Philippines within the Shearwater matrix management model (includes local Philippines leadership) to reach financial goals and productivity requirements.
4. Ensure Shearwater compliance with client service level agreements (SLAs) such as productivity and quality and develop and manage a quality assurance and other process to ensure SLAs are met to client expectations.
5. At other times, serve as a voice of the customer demand and assist Shearwater in creation of new service offerings to bring to the market.
6. This role is involved during the Discovery, Scoping and Term Sheet preparation phases of the sales process, during client meetings as necessary per the Account Manager, during the Quarterly Strategic Review preparation and client meetings, and during internal operational reviews.
7. This role functions as our internal expert liaison to the business, thinking strategically about our current service offerings and forecasting the client’s needs based on industry and client specific trends.
8. Represents Shearwater Health before and after MSA/SOW completion to help clients identify opportunities to realize improvements via utilization of Shearwater Health’s CPO services.
9. Maintains a balanced position when confronted with client concerns; demonstrates sensitivity towards customer issues, while ensuring that Shearwater Health’s policies, profitability, and marketplace reputation are protected.
10. Collaborate with Operations and Clinical Leadership in the United States and in the Philippines to ensure client directives are clearly defined.
11. Properly documents customer issues and resolutions using Shearwater Health’s CRM, notifies Sales/Account Managers regarding resolution of customer issues and any obstacles to meeting client expectations.
12. Gathers client volume and performance data, relative to service level agreements and invoicing requirements; participates in analyzing client trends as needed to improve productivity and quality. And shall at all times know the margin per product line, typical price range for the services both at Shearwater and in the industry and all related metrics for the payer vertical.
13. At times, will speak at industry specific conferences and venues on the uniqueness of Shearwater’s approach and the value it provides to our clients’ businesses.
14. Represent Shearwater in the market as a thought leader, writing white papers and blogs for the payer vertical highlighting the industry level challenges they are facing and how Shearwater’s solutions map to our clients’ success.
15. Provides the highest level of customer service to internal and external customers, including current or prospective clients of the Company, vendors, staff, business partners, or visitors.
16. Manages confidential client, financial and employee information with discretion and good judgment in accordance with department and Organization guidelines.
17. Demonstrates a strong, dependable work ethic.
18. Maintain compliance with laws and with confidentiality of client workflows, trade secrets, client information including PHI, HCCA internal processes and systems, HCCA client names, Shearwater competitive secrets, etc. during employment and for twelve months thereafter (what we mean is if you ever decide to leave Shearwater we do not want you to disclose any of this confidential information to any other person or company in compliance with law as it relates to PHI, for example, and for 12 months as it relates to Shearwater).