Director of Contracting & Payor Relations
New
J
JobgetherDental healthcare
Based in the United StatesFull-TimeDirector
Salary not disclosed
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Job Details
- Experience
- At least 8 years of experience in payor contracting, network management, or managed care, including a minimum of 3 years leading negotiations.
- Required Skills
- Microsoft Excel
Requirements
- Hold a bachelor's degree in Business, Finance, Healthcare Administration, or a related field.
- Have at least 8 years of experience in payor contracting, network management, or managed care.
- Have at least 3 years leading negotiations.
- Bring hands-on experience negotiating dental PPO fee schedules for a multi-location organization or working on the payor or network side.
- Have working knowledge of CDT coding, dental benefit design, leased networks, and claims adjudication.
- Demonstrate strong Excel-based financial modeling skills.
- Show a track record of securing and documenting reimbursement rate improvements.
- Have experience with provider credentialing and enrollment processes, including CAQH.
- Be prepared to present recommendations to CFOs, executive leadership, and board members.
- An MBA or MHA is an advantage.
- Experience in a dental support organization, multi-site healthcare environment, or private equity-backed organization is preferred.
- Experience with acquisition integration, medical billing for oral surgery, or Medicaid dental programs is a plus.
Responsibilities
- Develop and manage enterprise-wide payor strategies across commercial dental PPO plans, leased and umbrella networks, medical plans for oral surgery, and government programs.
- Lead fee schedule negotiations and renegotiations with national and regional carriers, including specialty-specific reimbursement schedules.
- Evaluate direct contracting versus leased network participation and recommend out-of-network or contract termination decisions using revenue projections and patient retention modeling.
- Create and maintain payor performance scorecards tracking patient volume, net collection rates, write-offs, and reimbursement for key procedure codes.
- Model proposed contract financial impacts and provide rate assumptions for budgeting, forecasting, and board reporting.
- Coordinate provider credentialing and payor enrollment so dentists are in network before seeing their first patients.
- Serve as the senior escalation point for systemic claim denials, underpayments, reimbursement downgrades, and payor recoupment demands.
- Assess payor agreements during acquisition due diligence and lead contract integration following acquisitions.
- Collaborate with Revenue Cycle, Operations, Clinical Leadership, and Compliance teams to improve payment accuracy, educate front-office teams, and communicate payor policy changes.
- Monitor state insurance regulations and assess their implications for contractual arrangements across operating markets.
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