Summary:-
The Director of Payer Relations is responsible for leading the organization's payer strategy, contract negotiations, and ongoing payer performance management to optimize reimbursement and support financial sustainability. This role serves as the primary liaison between the organization and commercial payers, driving strategic partnerships, ensuring contract compliance, and identifying opportunities to enhance revenue performance. The Director collaborates closely with Finance, Revenue Cycle, and Clinical Leadership to align payer arrangements with organizational goals, including value-based care initiatives, while proactively monitoring payer behavior, mitigating revenue leakage, and ensuring accountability to contract terms.
Required:-
Bachelor's Degree in Healthcare Administration, Business Administration, Finance, or related field
7-10 years of progressive experience in healthcare payer relations, managed care contracting, or revenue cycle
3-5 years of experience in leadership
Demonstrated experience leading complex payer negotiations and contract strategy
Preferred:-
Master's Degree in related field.
Experience with value-based care models and risk-based reimbursement arrangements
3-5 years of experience in payer contracting
Experience collaborating cross-functionally with Finance, Revenue Cycle, and Clinical Leadership
Essential Functions:-
Lead payer strategy and contract negotiations, including reimbursement rates, contract terms, renewals, amendments, and long-term financial goals.
Develop and manage reimbursement models, including fee-for-service, value-based care, shared savings, bundled payments, and risk-based arrangements.
Oversee contract performance through financial modeling, revenue impact analysis, reimbursement methodology review, and identification of opportunities to improve financial outcomes.
Partner with Finance, Revenue Cycle, Clinical Leadership, and Care Management teams to optimize reimbursement, address payer issues, and align incentives with quality and patient outcomes.
Manage key payer relationships, including commercial health plans, through ongoing collaboration, business reviews, issue resolution, and network strategy support.
Analyze payer performance, denial trends, underpayments, and contract results while providing executive-level insights and recommendations to support strategic decision-making.
Our Benefits:-
No State Income Tax
Medical, Dental, Vision, FSA, Telehealth
Paid Time Off, Mental Health, and Volunteer Days
100% Vested 401K & Roth with Company Contribution
Tuition Reimbursement
Referral Bonuses
On Site Education & Certification Programs
Base Wage Increases for Relevant Advanced Degrees
Free Calm App Subscription
401(k), Medical insurance, Vision insurance, Dental insurance, Tuition assistance