Director of Payer Relations

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.

Responsibilities

• 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.

Requirements

• 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.

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