Career Center

Overview

St. Luke's Health System, Idaho's only locally-owned health system, is seeking a Vice President, Payer Relations and Reimbursement - a critical role that holds responsibility for developing, executing and overseeing comprehensive payer relations, strategic reimbursement, pricing, and price transparency strategies for St. Luke's Health System (SLHS) Fee For Service (FFS) strategy.

This position will oversee the highly complex negotiation of payer contracts and develops and maintains collaborative working relationships with key payers and internal stakeholders.

Responsibilities

• Owns all elements of the FFS payer relationships. Develops and executes payer relations and reimbursement strategies, that compliment and support the organizations value-based strategy and to create and advance relationships with third-party payers and other contracting relationships.
• Establishes and maintains collaborative relationships with locally domiciled as well as regional and national payer entities to ensure contract terms and requirements are successfully implemented for optimal contract performance.
• Negotiates all FFS payer contracts, while ensuring standardization and consistency in payer contracting efforts which comply with company objectives and regulatory requirements.
• Oversees and coordinates FFS ancillary contract terms and reimbursement, including retail pharmacy, outreach laboratory, occupational health, et. al.
• Directs contract management efforts to ensure payer compliance with all payer contractual terms. Hold joint operating committee meetings with all payers. Partners with key internal stakeholders to identify and initiate needed operational changes to optimize payer FFS reimbursement.
• Develops SLHS FFS strategic pricing methodology. Develop detailed annual Charge Description Master price changes. Monitors SLHS market share, both overall and by product lines. Collaborates with Senior Product LineLeaders, Financial Leadership, et. al. to ensure appropriate reimbursement to maintain competitive alignment of reimbursement. Negotiates payer contracts to support market competitive pricing, positive performance, operationalefficiency, and compliance.
• Identifies the need for, procures and coordinates the activities of, external market share and reimbursement, andpricing consultants for FFS strategy as appropriate
• Advises Financial Leadership during budget cycles on appropriate gross pricing (charges) targets, and item gross charges to optimize net reimbursement and projected contractual allowances.
• Develops SLHS Price Transparency strategy, ensuring compliance with regulatory requirements, and monitors and evaluates SLHS web sites, estimation tools for effectiveness in maintaining SLHS market position and patient financialsatisfaction.
• Advises Executive Leadership on emerging trends and methodologies in FFS payer contracting and reimbursement, strategic pricing, and price transparency. Collaborates with Financial, Product-line, Legal, and St. Luke's HealthPartner leadership as appropriate in the implementation of SLHS payer and reimbursement strategies.
• Ensures leaders work in a collaborative manner and adhere to cross-functional governance principles to promotestandardization, sharing and adoption of best practices, appropriate scope of service, and stewardship of the Health System's resources.
• Creates an environment of integrity, compassion, accountability, respect, and excellence and promotes a culture of learning and innovation to facilitate the development of the strategic plan and the achievement of the strategic andoperational goals of the organization.
• Actively engages in system-level committees to support the achievement of strategic plans and objectives.
• Performs other duties as assigned.

Qualifications

• Education: Master's Degree in Business, Accounting/Finance or related field or 6 years of experience in lieu of degree.
• Experience: 12 years' relevant experience.

Why St. Luke's

A strong, talented staff is at the heart of St. Luke's Health System. We are the state's largest employer with more than 15,000 employees and a medical staff of more than 1,800 physicians and advanced practice providers. We're proud of our people who deliver skilled, compassionate care every day, and are looking to add dedicated individuals who will continue this same tradition of excellence.

Known as the "City of Trees," Boise is Idaho's capital city--both a cultural center and a playground for those who love the outdoors. A vibrant downtown area affords fine dining, theatre, music, and college and semi-professional sports. Downtown Boise's main attractions include the Idaho State Capitol, the classic Egyptian Theatre, the Boise Art Museum, Julia Davis Park and Zoo Boise. The Greenbelt follows the beautiful Boise River corridor for more than 30 miles, and the Boise foothills are home to miles of hiking and biking trails.

Learn more about what the City of Trees has to offer you:

St. Luke's Health System | Boise Convention and Visitors Bureau | Boise Parks and Recreation | Boise Museum Association | Boise Music Festival | Boise Philharmonic | Downtown Boise Restaurants | Boise Valley Economic Partnership | Hyde Park events | Treefort Music Festival | First Thursdays | Alive After Five | Capitol City Public Market | Runs and Triathlons | Shakespeare Festival | Sawtooth National Forest | Visit Idaho.org

*St. Luke's is an equal opportunity employer and does not discriminate against any person on the basis of race, religion, color, gender, gender identity, sexual orientation, age, national origin, disability, veteran status, or any other status or condition protected by law.