Director of Payer Relations & Contracting

Position Summary

The Director of Payer Relations & Contracting is responsible for leading the development, execution, and optimization of the organization's national and regional payer strategy. This role serves as a key liaison between the company and managed care payers, driving network expansion, negotiating contracts, and ensuring optimal reimbursement across a growing post-acute care footprint. The Director will play a critical role in strengthening relationships with healthcare commercial payers, Medicare Advantage plans, Medicaid organizations, and other managed care entities, while proactively identifying and resolving reimbursement challenges and supporting overall revenue integrity.

Responsibilities

• Develop and execute national and regional strategies to expand payer contracts and optimize network participation.
• Negotiate favorable contract terms, reimbursement rates, and value-based arrangements with commercial and government payers.
• Evaluate new network opportunities and maintain optimal in-network positioning.
• Analyze payer contracts to assess financial performance, reimbursement structures, and compliance requirements.
• Identify opportunities to improve margins, reduce administrative burden, and enhance contract terms.
• Partner with finance and operations teams to model contract performance and support strategic decision-making.
• Track and monitor all contract activity across assigned markets.
• Build and maintain strong relationships with payer executives and network management teams.
• Serve as the primary liaison between the organization and payer partners.
• Lead payer meetings, presentations, and high-level negotiations.
• Collaborate with revenue cycle management (RCM), billing, and operations teams to identify trends in denials, underpayments, and reimbursement discrepancies.
• Lead cross-functional initiatives to resolve payment issues and improve collections.
• Ensure compliance with third-party reimbursement requirements and documentation standards.
• Develop and update managed care strategies in collaboration with operational leaders, including defined goals, objectives, and performance tracking.
• Monitor market trends, regulatory changes, and competitive dynamics within the post-acute care industry.
• Support mergers and acquisitions by assessing payer contracts and integration strategies.
• Report payer relations activity and progress to senior leadership on a regular basis.
• Ensure proper documentation and tracking of expenses and reimbursement requests.
• Maintain confidentiality of sensitive payer and organizational information.

Qualifications

• Bachelor's degree in business, healthcare administration, or a related field preferred (or equivalent experience).
• Minimum of 5+ years of experience in payer relations, managed care contracting, or a post-acute healthcare setting.
• Experience in Durable Medical Equipment (DME), infusion therapy, or other post-acute services strongly preferred.
• Prior experience in sales or market development is a plus.

Knowledge & Skills

• Strong understanding of managed care contracting, reimbursement methodologies, and payer structures (Medicare, Medicaid, commercial).
• Proven track record of successful payer negotiations and contract management.
• Experience identifying and resolving denial and payment issues.
• Excellent analytical, financial, and problem-solving abilities.
• Strong organizational, communication, and interpersonal skills.
• Ability to work collaboratively in a matrixed environment and influence stakeholders at all levels.
• Self-motivated, results-oriented, and able to work independently.

Additional Requirements

• Ability to travel as needed (approximately 25%).
• Professional appearance and demeanor.
• Ability to maintain confidentiality and handle sensitive information.

Why Join Us?

• Opportunity to play a key role in shaping payer strategy within a growing, patient-focused organization.
• High-impact position with direct influence on financial performance and market expansion.
• Collaborative leadership environment with strong executive support.
• Competitive compensation package, including performance incentives and benefits.