About the Opportunity

Found is seeking an experienced, strategic-minded individual to join our metabolic healthcare organization as the Director of Payer Strategy and Contracting. In this individual contributor leadership role, you will be responsible for developing and executing comprehensive payer reimbursement strategies, building & fostering payer relationships, and negotiating contracts to ensure Found’s financial success while maintaining high-quality member care and service delivery. Your deep understanding of the healthcare payer landscape and proven track record in strategic planning, contract negotiation, and payer partnerships will be crucial in driving the Found’s payer reimbursement growth and success.

What You’ll Do (Job Responsibilities):

1. Payer Strategy and Relationship Management:

• Lead the strategic development, prioritization, and implementation of the Found's payer strategy to include:
• Early standard (rack rate) fee for service contracts (FFS)
• Negotiated fee for service contracts
• Partnerships such as value based care and/or bundled services contracts
• Analyze market trends, evolving reimbursement policies, and regulatory changes to identify opportunities and threats in the healthcare payer landscape
• Collaborate with cross-functional teams to support the design of innovative payer models that enhance member access, affordability, and overall healthcare experience
• Cultivate and maintain strong relationships with payer partners to drive better/negotiated reimbursement rates, successful contract renewals, and introductions to self insured employer lines of business
• Serve as the primary point of contact for payer negotiations, issue resolution, and ongoing communication
• Collaborate with internal stakeholders to ensure alignment between payer strategies, provider network development, and enterprise sales
• Stay informed about evolving healthcare industry trends, Found’s competitive landscape, payer regulation changes, including CMS, CMMI, HHS etc. as well as new or changing compliance requirements and other industry that impact payer contracts

1. Contract Negotiation and Regulatory Compliance :

• Lead contract negotiations with payers to optimize reimbursement rates, payment terms, and contractual terms and conditions
• Develop negotiation strategies that maximize revenue while ensuring sustainable financial performance, optimal clinical outcomes, and member satisfaction
• Stay updated on industry benchmarks and best practices to drive favorable contract terms
• Collaborate with the Found legal team to ensure that all payer contracts and negotiations adhere to legal and regulatory guidelines

1. Financial Analysis, Reporting, and Performance Monitoring:

• In coordination with the finance and analytics teams; conduct in-depth analysis of payer contracts, evaluating their impact on revenue, profitability, and overall financial health
• Monitor and assess contract performance, analyzing trends and variances to proactively identify opportunities for improvement
• Collaborate with the finance team to develop financial models and forecasts related to payer contracting
• Prepare and present regular reports to executive leadership and relevant stakeholders on payer strategy, contract performance, and market trends
• Communicate effectively with internal teams, external partners, and stakeholders at all levels to ensure alignment and understanding of payer initiatives

What You’ll Bring (Job Qualifications)

• Strong understanding of healthcare reimbursement methodologies, payer policies, and regulatory landscape
• Proven track record of successful payer contract negotiation and management
• Exceptional analytical, financial modeling, and negotiation skills
• Excellent communication and interpersonal skills, with the ability to collaborate effectively across internal departments at all levels and with external partners
• Knowledge of healthcare industry trends, value-based care, and alternative payment models.
• Ability to adapt to a fast-paced and evolving healthcare start up environment
• Demonstrated leadership experience, including managing teams and driving strategic initiatives
• Passionate about supporting the delivery of safe, high-quality obesity & metabolic healthcare, and harnessing technology to do so
• Strong, demonstrated aptitude for problem solving. Must be able to identify and address barriers to care, such as financial or logistical challenges, and develop creative solutions to ensure members receive industry leading care
• Exceptional organizational abilities, with the ability to organize and prioritize competing priorities
• Demonstrated ability to prioritize and manage multiple tasks and projects at various stages of completion, and ensuring their successful completion
• Must be very comfortable and proficient using technology in daily work, projects, and communications

Minimum required education and experience:

• Bachelor's degree in Healthcare Administration, Business, or a related field
• At least 5 or more years of progressive experience in healthcare payer strategy, contracting, contract negotiation, and payer relationship management

Bonus Points:

• Master’'s degree in Healthcare Administration, Business, or a related field;
• 6-10+ years of progressive experience in healthcare payer strategy, contracting, contract negotiation, and payer relationship management

What You’ll Get (Benefits & Perks)

• Competitive compensation
• Medical, dental, vision, and life insurance
• Flexible PTO, company-paid holidays, parental leave
• 401K, wellness and wifi perks
• Flexible, remote-first work culture

Found is an Equal Opportunity Employer. We seek and celebrate diversity in its many forms. If you’re excited about this opportunity but do not meet 100% of the qualifications, we encourage you to apply.

Please review our CCPA policies.