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Vice President Payor Relations

Summary:

 

We’ve been retained by Specialty1 Partners, www.specialty1partners.com, to find a Vice President, Payor Relations.  This is a newly created role for a very quickly growing and industry leading, very successful specialty dental platform.  The Vice President, Payor Relations will oversee all activities related to engagement with insurance partners across their network of practices, including development of payor relations strategy, engagement with Specialty1 practices to implement payor strategies, payor contract negotiations and management, maintenance of payor fee schedules, and provider credentialing & enrollment.  This position will report directly to the COO and can be based anywhere in the continental US. 

Company:

 

Specialty1 Partners is a dental services organization (DSO) committed to providing non-clinical, business support services to the nation's leading specialty dental practices.  The company was founded in 2019 by four endodontists who wanted to provide unique and differentiated support to specialty dental practices.  Originally focusing on support to endodontics practices (under the Endo1 brand), Specialty1 Partners quickly expanded its support to periodontics and oral surgery practices. 

 

Since its founding, Specialty1 Partners has grown rapidly to become one of the largest private owners of specialty dental practices in the US.  Headquartered in Houston, TX, Specialty1 Partners is led by its founders and a management team that is focused on ongoing growth and delivery of best-in-class services across its network of practices.  As of November 2023, Specialty1 Partners has over 220 locations across 28 states.

 

The Position:

 

This person will report to Nate Mote, Chief Operating Officer.  Nate has years of success leading strategic

operations.  Nate began his career in the U.S. Navy as a nuclear submarine officer after attending the U.S.

Naval Academy.  He then developed his strategic business and leadership experience working with teams

at the Boston Consulting Group, Wunderman and Marriott International, and prior to his role with

Specialty1 Partners, was the VP of Operations for Specialty + Emergency business at National Veterinary

Associates, the largest private owner of freestanding veterinary clinics in North America.  During his time

there, NVA quadrupled the specialty and ER business line and grew from 30 to 100+ hospitals in 4 years.

 

The VP, Payor Relations will oversee all activities associated with Specialty1’s insurance partners across our

network of practices.  These activities include:

  • Establish and implement strategic goals for the payor relations department, which align with overarching corporate goals and objectives.

  • Effectively manage the growth and development of team members supporting Payor Relations functions:

    • Upon hiring, the VP Payor Relations will have 2 direct reports (Credentialing Manager and Payor Relations Manager); the VP will manage the growth of this team over time, including ongoing training and development of team members.

    • Conduct regular meetings with team members to ensure that they are well informed of company goals and objectives, to set priorities, and to discuss progress towards goals.

    • Develop performance matrices and mechanisms for regular feedback on staff accomplishments and areas of development.

  • Serve as the company’s primary contact for payor contracting support, to include:

    • Negotiate better payor fee schedule rates as the organization gains leverage through growth.

    • Assess payor contracting requirements and standards as they relate to industry / regulatory issues and market implications.

    • Recommend and implement necessary improvements and revisions to contracting requirements and standards.

    • Support resolution of payor contractual issues pertaining to contract interpretation and coding with payors in conjunction with revenue cycle staff.

  • Drive value to the organization through successful management of payor contracts and practice pricing over time, to include:

    • Lead the development of a contract pricing model and drive all activities related to the modeling of contract proposals that maximize net operating margins and ensure market competitiveness.

    • Evaluate and provide recommendations to update internal UCRs, to ensure that billing practices are positioned for maximum revenue.

    • Ensure that payor fee schedules are updated on a regular basis and are uploaded appropriately in local practice management systems.

    • Evaluate charge integrity periodically by performing an analysis of charges and reimbursement for common procedures.

    • Oversee development and utilization of reports and analytics used for contract management.

  • Manage and monitor the provider credentialing & enrollment department, to include:

    • Maintain up-to-date credentials for each licensed provider, including verification through primary and secondary sources, records, and relay credentialing information as needed.

    • Keep accurate records of provider licensure/ certification renewals.

    • Coordinate provider enrollments in all commercial, state, and federal insurance programs; correspond with and provide updates to insurances.

    • Develop and implement a strategy over time to adopt more Delegated Agreements with payors, including associated audit and reporting requirements.

  • Provide communications throughout the organization on activities and progress of the Payor Relations department, to include updates to individual practices, partner doctors, other corporate departments, and the executive leadership team.

Ideal Candidate:

 

  • Deep background in Payor Relations in a DSO or similar environment:

    • 7+ years’ experience in functions related to payor relations (e.g., payor negotiations, credentialing).

    • 3+ years’ experience in team management and supervisory support, including growth and development of a payor relations team over time.

    • Experience in dental payor relations is strongly preferred; hybrid experience with medical payors is ideal.

  • Leadership & relationship-driven:  builds great relationships with team members, Specialty1 practice leaders, corporate partners, executive leaders, and key representatives of insurance partners; delegates appropriately and uses talents of the team in best combination.

  • Proven ability to drive value through a strategic approach to payor relationships, and to drive execution of that strategy through engagement and negotiation with payors across a distributed dental network.

  • Strong knowledge of credentialing, to include knowledge of credentialing software, NCQA credentialing standards, best practices for centralized credentialing & enrollment support to a distributed network of practices, and insights on credentialing delegation agreements.

  • Results-driven:  works independently and effectively towards agreed-to goals and objectives, strong analytical background with ability to identify insights and drive results based on metrics and KPIs

  • Polished executive presence:  close attention to detail, excellent written and verbal communications at all levels of the organization, strong interpersonal skills and experience interacting with clinical and administrative team members

  • Education:  Bachelor’s degree in a relevant subject is preferred; must have experience with key Microsoft applications (Teams, Outlook, Excel, Powerpoint, PowerBI)

 

Contact:

If this is something you’re open to learning more about, I’m happy to talk with you and share more.  You can reach me at 501-519-2514 or let me know the best time and # to reach you at.  If not for you, feel free to share this information as it is a great opportunity for someone.

 

Choose to make it a great day!

 

Don Rottman    

don@rottmangroup.com

501-519-2514 cell

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