Job/Position Overview: Director of Payor Relations builds and maintains relationships with internal and external sources involved in the payor contracting process; drives contracting and negotiation strategy. In addition, serves as a liaison with the revenue cycle team and other internal staff on implementation of contracts and compliance to contract terms to ensure providers are receiving appropriate reimbursement, to ensure rules and requirements are followed and to prepare for renegotiations. The role interacts with internal and external parties regarding communication/questions about rates and terms, rate structure and development and reconciliation of contract provisions and disputes. The role is responsible for tracking all contracts across all facility locations and supporting reimbursement rate renegotiations, when eligible.
Education: Bachelor's degree in health care administration, business, or other related field is required; advanced degree is preferred.
Training & Experience: 5+ years of experience in health plan contracting, operations, service operations or provider relations experience required.
Specialized Skills and Knowledge:

• Skill in problem solving in a variety of settings.
• Basic Knowledge of professional accounting.
• Skill in time management and project management.
• Proficiency in Microsoft Excel, Teams, and SharePoint.
• Ability to work independently and take initiative.
• Ability to deal effectively with change and be a change agent.
• Ability to willingly accept responsibility and delegate responsibility as needed.
• Ability to set priorities and use good judgment for self and staff.

Duties & Responsibilities of the Position:

• Negotiates and renegotiates insurance payor and managed care contracts.
• Coordinates the administrative, legal, operational, and financial issues related to contract negotiation.
• Maintains a comprehensive payor database.
• Assists internal team with all matters relative to payor contracts.
• Works with finance team to develop and validate financial models needed to assess reimbursement opportunities presented during contract negotiations.
• Collaborates with the revenue cycle management team to monitor accounts receivable, identify trends, and develop processes for resolution, implementation, and ongoing evaluation. Secures resolution of outstanding accounts receivable through contract relationships with managed care plans.
• Coordinates and leads meetings with contracted payors whereby outstanding credentialing, accounts receivable, and other operational issues are addressed and resolved.
• Negotiate and operationalize payor contracts
• Drive the development and implementation of payor strategy
• Analyze current data that influences payor strategy and assist in the development of tools to monitor and expand visit revenue
• Proactively monitor and report current contracting efforts
• Partner with leadership to ensure that contracting efforts align with business goals
• Communicate with relevant stakeholders to ensure contract commitments are operationalized

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Job Type: Full-time

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