Vice President, Payer Strategy

About us:

Founded in 2017 by Carolyn Witte and Felicity Yost, Tia is the modern medical home for women. We are trailblazing a new paradigm for women’s healthcare that treats women as whole people vs. parts or life stages.  Blending in-person and virtual care services, Tia’s “Whole Woman, Whole Life” care model fuses gynecology, primary care, mental health and evidence-based wellness services to treat women comprehensively. By making women’s health higher quality and lower cost, Tia makes women healthier, providers happier, and the business of care delivery stronger — setting a new standard of care for women everywhere.

Tia has raised more than $132 Million in venture capital funding to date, including a recent $100 Million Series B investment, one of the largest early-stage rounds ever for a healthcare company focused on women. Tia has ambitious plans to scale its “whole-woman, whole-life” model to more than 100,000 women by 2023. We’ll do this by growing virtual and in-person operations in existing and new markets while expanding its service lines to care for women throughout their entire lives -- from puberty to menopause. Since launching in 2017, Tia has grown to serve thousands of women aged 18-80 with blended in-person and virtual care in New York City, Los Angeles, Phoenix and soon San Francisco. 

We’re building a world class team to reimagine women’s healthcare. We’re an interdisciplinary team of clinicians, researchers, designers, technologists and operators who have seen firsthand how broken the healthcare system is for women. We’re united by a powerful mission to enable every woman to achieve optimal health, as defined by herself, as well as a shared set of values and principles that define our business, products, and culture. 

Our company values: 

• Health & Wellbeing: We believe that health & wellbeing is a fundamental human need and right. We prioritize the health & wellbeing of our employees and their families.
• Compassion: We believe that compassion is as important as information and care itself. We imbue compassion into our care, leadership, and communication.
• Individual Agency: We believe that every person has a responsibility to enact their agency for the betterment of themselves and others. We encourage all employees to call out problems and advocate for solutions.
• Collaboration: We believe that collaboration engenders creativity and outsized impact more than hyper-specialized or individualistic approaches to solving problems. We believe collaboration fosters different perspectives, experiences, and skillsets.
• Aspirational Thinking: We believe that aspirational thinking leads to higher quality work and transformative outcomes. We encourage all employees to think through problems and reach for solutions that raise the bar.

Role Title: VP, Payer Strategy

Location: Remote (SF, NY, LA)

Team: Commercial Growth

Manager: CEO

Role Summary: We’re looking for a VP of Payer Strategy to play a critical role in achieving Tia’s mission of making Tia’s higher quality care model accessible by maximizing the # of women who can use their insurance coverage for any services they receive at Tia — while also maximizing Tia’s reimbursable revenue growth.

To this end, the VP of Payer Strategy must be a “general athlete” — a gifted sales person who is both a big picture thinker and detail-oriented operator. 

• You’re excited (vs. overwhelmed) by thinking through “big picture” strategy — like developing a multi-year, phased roadmap to diversify Tia’s reimbursement revenue from (just) traditional FFS contracts to include innovative payment types that capitalize on Tia’s unique strengths (e.g., value-based bundles). 
• You also get satisfaction from the “nitty-gritty,” with a propensity to roll up your sleeves to GSD — whether it’s negotiating contracts in each market, understanding the nuances/asymmetries across markets and payers to strike optimal deals, or supporting systemic implementation of those deals by collaborating with our Ops and Tech teams. 

Responsibilities:

• Payer Contracting: Build and lead Tia’s “payer contracting machine” that is responsible for organizing and optimizing our existing contracts, as well as securing/negotiating new contracts.
  • Maximize Tia’s in-network TAM, in existing and new markets: Ensure every existing and new Tia clinic is in-network with the vast majority of commercial plans — via multiple contracting channels (e.g., direct contracting, arrangements with health systems through IPA/CIN/joint venture models) — and across all service lines (including primary care and gynecology, as well as the trickier-to-contract behavioral health and wellness services such as acupuncture, nutrition, massage). 
  • Maximize Tia’s reimbursement revenue by (a) negotiating the best possible contracted rates (as % of CMS) and (b) holding payers accountable to reimbursing Tia within those contracts (as informed by Tia’s RCM/Finance team). 

• Payer Relations & Biz Dev: Be the primary “face of Tia” to payer audiences, including executives. Effectively pitch Tia’s relevant value props to create leverage that (a) gives Tia more negotiating power on standard contracts; and (b) to sell in deeper, innovative partnerships that unlock a new payer-first GTM pathway for Tia. 
  • Manage relationships with existing payers (sometimes managed directly, sometimes through health system partners): Pitch and represent Tia (and our value props) to payer executives, and collaborate with health system partners to ensure ongoing synergy of Tia’s payer <> health system partnerships.
  • Identify opportunities for payer growth in existing markets (via expanding Tia’s list of accepted plans) and lay the groundwork with payers “from scratch” in net-new markets — with the goal of ensuring all service lines are in-network for at least 75% of our local addressable market by clinic launch. 

• Payment Model Innovation & Roadmapping with an eye to setting Tia up for success in an increasingly value-based healthcare market.
  • Build a multi-year, multi-pronged payer strategy that transitions Tia from traditional FFS contracts to more innovative payment models (e.g., value-based bundles) that capitalize on Tia’s unique strengths and care model . . . all with minimal disruption to the business.
  • In parallel, identify new reimbursement opportunities that maximize Tia’s revenue in an FFS model — especially for “stuff Tia does” that doesn’t fit a standard CPT code (e.g., billing through collaborative care codes, care coordination codes, etc.)
    • For example: Find — and secure Tia’s participation in — innovative PCP programs with commercial payers that reward Tia’s unique care model (e.g., the Patient-Centered Medical Home model run by Blue Cross Blue Shield).

• Cross-Functional Planning & Implementation: Context: Changes in our reimbursement model/flow has implications for every part of the business — from our provider-facing tech, to clinical operations, to clinical research & quality metric management. Your role is to be the grand “conductor” unifying and directing the many groups within Tia’s matrixed “orchestra” — gathering inputs from key stakeholders, and collaborating with them to drive implementation across the org (especially Product, Clinical Ops, Clinical Innovation).
  • Serve as the go-to SME on all things payers, and as the source of truth in interpreting & communicating contracts
  • Collaborate closely with the Care Model org (which includes Product/Tech, Clinical, Finance, Ops) to operationalize any changes made to how we contract and/or bill payers.
  • Collaborate with Tia’s Revenue Cycle Manager on RCM process improvements aimed at enhancing collections, preventing revenue leakage, increasing compliance, and optimizing reported revenue. Advise on their improvement efforts and be responsive to general inquiries regarding industry best practices.
  • Collaborate with Tia’s Payer Relations Manager on credentialing process improvements that increase the efficiency of our provider credentialing efforts. Advise on whether our software (e.g. Medallion) usage and team is right-sized for our evolving scale and desired outcomes.
  • Serve as the “payer” lead in Tia’s “Quality” SWAT team — developing Tia’s short- and long-term approach to quality metrics (i.e., how we measure, track, improve, and report on quality metrics in a way that matters to not only to payers, but health system partners.)

Experience & Skills

• 7 years experience with payer contracting, payer sales (ideally in health tech / a startup environment)
• Experience bringing an organization in network on a FFS basis
• Experience transitioning an organization from pure FFS to the wide spectrum of pay-for-performance and value-based agreements
• Proven sales and negotiation skills — to source and close payer deals with unusually favorable terms
• Experience operationalizing company strategy at a high level, but willingness to dig into the weeds when needed
• Exceptional collaboration skills with personal qualities of humility, empathy, and curiosity

Benefits: 

• Unlimited vacation
• Free Tia membership
• Competitive stock option package
• $300 one-time WFH stipend
• $50/month phone and internet reimbursement 
• Medical, dental, and vision benefits
• 401k program (no matching at this time)
• Top of the line 13" Macbook Pro 
• Travel stipend for team off-sites

This position may require attendance at company and team off-sites and is subject the Company’s vaccine requirement, as permitted by law and subject to reasonable accommodation.