Director of Payor Contracting & Relations bei Precision Healthcare Specialists

Description

The Director of Payor Contracting and Relations is responsible for managing payor relationships, contract negotiation, and optimization across multiple healthcare entities within the organization. This role serves as the primary liaison between the organization and commercial insurance payors, government programs, and managed care organizations to ensure favorable contract terms, accurate reimbursement, and strategic positioning in the market. Working with the SVP, the Director will develop and implement contracting strategies that align with organizational growth objectives while maximizing revenue and maintaining strong payor relationships across all business units.

KEY RESPONSIBILITIES:

Contract Negotiation & Management

• Lead contract negotiations with commercial payors, Medicare Advantage plans, Medicaid managed care organizations, and other third-party payors across multiple healthcare entities

• Develop and execute comprehensive contracting strategies that support organizational financial goals and market expansion

• Analyze contract proposals, fee schedules, and reimbursement methodologies to ensure optimal financial outcomes

• Manage the complete contract lifecycle including drafting, negotiation, execution, implementation, and renewal processes

• Coordinate with legal counsel on contract language, terms and conditions, and risk mitigation strategies

• Maintain centralized contract repository and ensure all agreements are current, accessible, and properly documented

Financial Analysis & Strategy

• Conduct comprehensive financial modeling and analysis of proposed contract terms and reimbursement rates

• Monitor contract performance metrics including reimbursement trends, denial rates, and payment accuracy

• Identify opportunities for rate improvements and contract optimization across all payor relationships

• Collaborate with finance team on revenue forecasting and budget planning related to payor contracts

• Analyze market trends, competitor positioning, and payor network adequacy to inform negotiation strategies

Relationship Management

• Build and maintain strategic relationships with payor representatives, network managers, and key decision-makers

• Serve as primary point of contact for payor-related issues, disputes, and escalations

• Partner with operations leadership to address payor requirements and resolve operational challenges

• Coordinate with provider relations and credentialing teams to ensure seamless provider network participation

Compliance & Risk Management

• Ensure all contracts comply with federal and state regulations, including Medicare, Medicaid, and commercial insurance requirements

• Monitor regulatory changes affecting payor contracting and implement necessary adjustments

• Develop and maintain policies and procedures for contract management and payor relations

• Identify and mitigate contractual risks across the organization

Team Leadership

• Build, lead, and mentor a high-performing payor contracting team supporting multiple entities

• Provide guidance and support to revenue cycle staff on payor contract interpretation and implementation

• Develop team capabilities in contract analysis, negotiation techniques, and relationship management

• Foster a collaborative culture focused on achieving optimal outcomes for the organization

Requirements

Education:

• Bachelor's degree in Business Administration, Healthcare Administration, Finance, or related field required

• Master's degree (MBA, MHA, or related) preferred

Experience:

• Minimum 7-10 years of progressive experience in payor contracting, with at least 3-5 years in a leadership role

• Demonstrated experience managing contracts across multiple healthcare entities or facilities

• Proven track record of successful contract negotiations resulting in favorable rate improvements

• Experience in rapidly growing healthcare organizations preferred

Knowledge & Skills:

• Expert knowledge of healthcare reimbursement methodologies, including fee-for-service, capitation, value-based arrangements, and bundled payments

• Deep understanding of commercial insurance, Medicare, Medicaid, and managed care contracting

• Strong financial acumen with ability to analyze complex fee schedules and model financial impact

• Excellent negotiation skills with demonstrated ability to achieve win-win outcomes

• Proficiency in contract management systems and revenue cycle applications

• Advanced Excel skills for financial modeling and data analysis

• Strong understanding of healthcare regulations, compliance requirements, and legal considerations in contracting

Competencies:

• Strategic thinking with ability to align contracting activities with organizational objectives

• Exceptional analytical and problem-solving abilities

• Outstanding communication and presentation skills for diverse audiences

• Strong relationship-building and interpersonal skills

• Ability to manage multiple priorities and complex projects simultaneously

• High attention to detail and organizational skills

• Collaborative leadership style with ability to influence across organizational levels

________________________________________

PREFERRED QUALIFICATIONS:

• Experience with Medicaid and Medicare Advantage contract negotiations

• Knowledge of value-based care models and alternative payment methodologies

• Experience implementing payor contracts in new states or markets

• Familiarity with credentialing processes and provider enrollment

________________________________________

WORKING CONDITIONS:

• Professional office environment with hybrid/remote flexibility

• Extended hours may be required during critical negotiation periods

• Occasional evening or weekend work for deadline-driven projects