Director of Payor Relations

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee all relationships with payors, including contracts, negotiations, and strategic initiatives within a designated regional portfolio.

• Lead discussions with commercial, Medicare Advantage, and Medicaid managed care plans.

• Maintain comprehensive knowledge of the payor landscape, including contract status, network participation, fee schedule benchmarks, and market dynamics.

• Cultivate senior-level relationships with health plan contracting and network management teams.

• Ensure that contracts, fee schedules, amendments, and provider enrollment statuses are accurate, compliant, and up-to-date.

• Address complex payor issues such as claims disputes, authorization denials, credentialing holds, payment variances, and systemic billing challenges.

• Oversee contract modeling, reimbursement methodologies, fee schedules, and contract term dates.

• Translate contract terms and state-specific requirements into operational guidance.

• Monitor payor performance, reimbursement trends, policy changes, revenue leakage, underpayments, and denial patterns.

• Conduct market assessments and address network participation gaps.

• Create financial models, benchmarking analyses, rate impact assessments, dashboards, and KPI reporting.

• Formulate and implement regional payor strategies aligned with growth targets, expansion timelines, and net revenue objectives.

• Identify opportunities for revenue enhancement through renegotiations, rate adjustments, and denial reduction initiatives.

• Stay informed about CMS policies, state regulations, and developments in commercial payors.

• Evaluate potential expansion markets and identify payor targets, network gaps, and contracting timelines.

• Direct payor outreach, contract execution, and enrollment coordination for new market entries.

• Assist in enterprise-wide payor strategy initiatives led by the VP of Payor Strategy.

• Facilitate cross-functional communication, education, and process standardization.

• Establish and uphold SOPs for consistent execution, new site launches, and market expansions.

• Collaborate with Credentialing and Enrollment on provider participation.

• Report regional payor performance, risks, and strategic updates to the VP of Payor Strategy.

⛳️ Requirements

• Bachelor’s degree in Healthcare Administration, Business, Finance, or a related discipline.

• 8+ years of progressive experience in managed care contracting, payor relations, or healthcare revenue cycle within a multi-site or multi-state organization.

• Proven experience in managing or leading teams, functions, or cross-functional initiatives.

• Extensive knowledge of commercial payor structures, as well as variations in Medicare Advantage and Medicaid managed care across multiple states.

• Strong analytical skills to interpret reimbursement terms, model contract scenarios, and convert claims data into actionable strategies.

• Demonstrated success in negotiating and executing complex payor contracts that yield measurable positive revenue impacts.

• Proficiency in contract modeling tools, RCM systems, and analytics platforms such as Tableau or equivalent.

• Excellent communication and relationship-building skills with payor executives, internal leadership, and cross-functional stakeholders.

• Ability to manage multiple complex projects across regions while balancing competing priorities with minimal day-to-day oversight.

• Experience in a PE-backed, multi-state healthcare organization, MSO, specialty medical group, or ASC environment.

• Preferred: familiarity with multi-state credentialing, provider enrollment, and taxonomy compliance.

• Preferred: knowledge of value-based care, risk arrangements, and payor quality programs.

• Preferred: experience with Athena Practice or a similar practice management and RCM platform.

• Preferred: established relationships with national and regional commercial payor contracting and network management teams.

🏝️ Benefits

• Commitment to growth, advancement, and professional development.

• Equal opportunity workplace.

• Compensation and benefits administered in accordance with applicable laws.