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VP, Payer Operations at WellSky

Posted in Other 30+ days ago.

Location: Overland Park, Kansas





Job Description:

WellSky is looking to hire a Vice President (VP), Payer Operations. The mission of the VP, Payer Operations is to successfully build, manage, and grow WellSky payer relationships and outperform the operational targets for each including but not limited to network size and adequacy; network satisfaction; member satisfaction; members being served; member engagement targets; various operational workflow targets; and outcomes targets. The over-all, focused goal of the VP of Payer Operations -- is to ensure success of WellSky's strategic payer relationships. This position will expand as the payer business, considered WellSky's most strategic opportunity, continues to grow and expand.


A day in the life!


You will be responsible for the following:



  • Rapidly learn WellSky's solutions and enablement capabilities and align them to the requirements and success criteria of each strategic payer relationship,

  • Working with other WellSky executives, rapidly refine our operational plan to ensure overachievement of payer-facing metrics;

  • Interface with strategic payer clients as the relationship manager and "directly responsible individual" (DRI) to ensure the success of the business and the partnership, including driving clear and aligned goals and execution across both parties

  • Manage cross-functionally across WellSky operations to ensure we exceed expectations including:

    • Network Operations

      • Network Contracting and Engagement. Matrixed management of customer success and marketing operations to build, maintain and nurture our networks of agencies among WellSky's customer base to support WellSky's payer clients

      • Network Performance Management. Manage the networks of WellSky agency customers to communicate, support, and enforce standards and ensure world-class member satisfaction.

      • Manage payer-related internal training programs - as well as agency-facing training programs, including across the WellSky networks

      • Across WellSky BUs as relevant, ensure the agency and payer-facing Support readiness as required to support payer programs





  • Product Development. Ensure Product and Engineering delivery related to payers as the programs' needs evolve








    • TPA and Other Operations.

      • Help build and support our Third-Party Administrator (TPA) capabilities as we process payments from payers, and in turn pay WellSky agency clients

      • Evolve marketplace capabilities to optimize pricing and liquidity while reducing marginal costs to payers and risk-bearing providers of engaging and deploying care models across the WellSky networks

      • Streamline TPA operations leveraging WellSky's position as the EMR to make claims adjudication and mitigation of fraud, waste and abuse highly efficient, and materially more efficient than TPA offerings lacking our structural advantage





  • WellSky Payer Operations

    • Rapidly build and deploy WellSky core capabilities for payer operational support including capabilities for patient scheduling; exception handling; and telemedicine capabilities

    • Ensure adequate staffing of "WellSky-owned" capabilities, that will report in to this role, to identify unexpected operational challenges and manage any exceptions and deliver the engagement success criteria




Do you have what it takes?


Required Experience:



  • Successful track record designing, building, and managing complex national enterprise payer relationships lasting a year or more with multiple stakeholders

  • Large-scale operations, logistics, and healthcare experience paired with executive level cross-functional leadership of technology solutions; enterprise relationship management; customer success; clinical services; and sales and marketing. TPA operations experience also preferred.

  • Has managed cross-functionally through influence against competing priorities

  • Professional services experience preferred (ex. consulting, investment banking, private equity)

  • Ability to move seamlessly and quickly from the strategic, innovative, "big picture" to the finest details to ensure operational success

  • Ability to move with the speed, agility, and alacrity necessary to create new, foundational capabilities from the ground up

  • Superb C-suite diplomatic and relationship management skills

  • Growth mindset - Ability to operate with lean resources and be "hands on" as necessary and "do what it takes" to exceed expectations for your teammates, our customers, and our partners

  • Systems thinking, with operational and process focus and unrelenting attention-to-detail

  • Experience building a compliant organization in a complex regulatory environment

  • Highly analytical and metrics-focused


Preferred Experience:



  • MBA degree

About WellSky


WellSky is a leading supplier of software and services solutions that help acute, post-acute, and human service providers improve efficiency, support business growth, and provide intelligent care to patients and people in need. WellSky is headquartered in Overland Park, KS with 1,800 teammates across the U.S. and Canada WellSky serves more than 20,000 client sites around the world - including the largest hospital systems, blood banks and labs, in-home care agencies, post-acute care facilities, government agencies, and human services organizations. WellSky's software and services address the continuum of health and social care - helping businesses, organizations, and communities solve touch challenges, improve collaboration for growth, and achieve better outcomes through predictive insights that only WellSky solutions can provide. Informed by 40 years of providing software and expertise, WellSky anticipates providers' needs and innovates relentlessly to help people thrive. Our purpose is to empower care heroes with technology for good, so that together, we can realize care's potential and maintain a healthy, flourishing world.


We're looking for talented individuals who want to use their skills to build a strong, technology-driven company. We offer competitive salaries, great benefits, a new Health Savings Account with a generous employer contribution and a casual and fun environment that encourages quality, creativity and excellence. Enjoy all we have to offer. We invite you to join us. Apply today!


As of December 8, 2021, as a condition of employment, all US-based employees must be fully vaccinated against COVID-19 unless a medical or religious exemption is approved.


WellSky provides equal employment opportunities to all people without regard to race, color, national origin, ancestry, citizenship, age, religion, gender, sex, sexual orientation, gender identity, gender expression, marital status, pregnancy, physical or mental disability, protected medical condition, genetic information, military service, veteran status, or any other status or characteristic protected by law. WellSky is proud to be a drug-free workplace.


Applicants for U.S. based positions with WellSky must be legally authorized to work in the United States. Verification of employment eligibility will be required at the time of hire.



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