Director of Payer Relations & Contracting
New
United StatesFull-TimeDirector
Salary not disclosed
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Job Details
- Experience
- 5+ years
Requirements
- Bachelor’s degree in business, healthcare administration, or related field preferred, or equivalent experience.
- 5+ years of experience in payer relations, managed care contracting, or post-acute healthcare environments.
- Strong experience with Durable Medical Equipment (DME), infusion therapy, or similar post-acute care services preferred.
- Proven track record of successful payer negotiations and contract management across commercial and government payers.
- Deep understanding of reimbursement methodologies, managed care structures, and payer systems (Medicare, Medicaid, commercial).
- Strong financial, analytical, and problem-solving skills with the ability to interpret complex contract structures.
- Experience identifying and resolving reimbursement issues such as denials and underpayments.
- Excellent communication, relationship-building, and stakeholder influence skills across executive-level audiences.
- Ability to work independently in a fast-paced, matrixed environment while managing multiple priorities.
- Willingness to travel approximately 25% as needed.
Responsibilities
- Develop and execute national and regional payer contracting strategies to expand network access and optimize reimbursement performance.
- Lead negotiations with commercial, Medicare Advantage, and Medicaid payers to secure favorable contract terms, rates, and value-based arrangements.
- Manage the full lifecycle of payer contracts, including evaluation, performance monitoring, compliance, and optimization opportunities.
- Analyze reimbursement structures and financial performance to identify margin improvement and operational efficiency opportunities.
- Build and maintain strong relationships with payer executives and network management teams, serving as the primary organizational liaison.
- Lead high-level payer meetings, presentations, and negotiations to resolve issues and strengthen partnerships.
- Collaborate with revenue cycle, billing, and operations teams to address denials, underpayments, and reimbursement discrepancies.
- Support revenue integrity initiatives by improving claims performance and payment resolution processes.
- Monitor market trends, regulatory changes, and competitive dynamics impacting payer strategy and reimbursement models.
- Support mergers, acquisitions, and market expansion efforts through payer contract assessment and integration planning.
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