Director of Payor Relations

🕒 Outubro 23

🇺🇸 Estados Unidos – Remoto (EUA)

⏰ Tempo Integral

🔴 Especialista

👔 Diretor

👻 Score fantasma 10%

O que significa: a chance de ninguém estar realmente contratando para esta vaga.Como ler: 60% ou mais significa que achamos que é uma vaga fantasma. Pontuações mais baixas preocupam menos.Por que essa pontuação:

• Aberta há 21 dias.
• As vagas desta empresa costumam ser preenchidas em 21 dias.
• Sem salário divulgado.

Candidatar-se

Adaptar currículo + carta de apresentação

Encontrar Vagas Remotas Similares

☆ Salvar☑️ Marcar como candidatado❌ Ocultar

Reportar problema

Metro Vein Centers

SiteLinkedInTodas as Vagas

501 - 1000 funcionários

Fundada em 2008

💼 Consultoria

📦 Logística

🏥 Saúde

Consulting • Logistics • Healthcare

O Metro Vein Centers é uma rede de clínicas ambulatoriais de veias, com acreditação nacional, que oferece diagnósticos centrados no paciente e tratamentos minimamente invasivos para varizes e veias superficiais. A empresa opera clínicas em diversos estados dos EUA, com especialistas em veias certificados, oferecendo procedimentos como ablação por radiofrequência e laser, escleroterapia e Venaseal, com muitos tratamentos cobertos pelo seguro de saúde. O Metro Vein Centers enfatiza cuidados de ponta, guiados por ultrassom, alta satisfação do paciente, avaliações gratuitas e alívio médico e estético para doenças venosas.

Descrição

• Own all payor relationships, contracts, negotiations, and strategic initiatives across an assigned regional portfolio • Lead negotiations with commercial, Medicare Advantage, and Medicaid managed care plans • Maintain payor landscape knowledge, contract status, network participation, fee schedule benchmarks, and market dynamics • Build senior-level relationships with health plan contracting and network management teams • Keep contracts, fee schedules, amendments, and provider enrollment statuses accurate, compliant, and current • Resolve complex payor issues including claims disputes, authorization denials, credentialing holds, payment variances, and systemic billing problems • Manage contract modeling, reimbursement methodologies, fee schedules, and contract term dates • Interpret contract terms and state-specific requirements into operational guidance • Monitor payor performance, reimbursement trends, policy changes, revenue leakage, underpayments, and denial patterns • Conduct market reviews and close network participation gaps • Develop financial models, benchmarking analyses, rate impact assessments, dashboards, and KPI reporting • Develop and execute regional payor strategy aligned with growth targets, expansion timelines, and net revenue goals • Identify revenue improvement opportunities through renegotiations, rate corrections, and denial reduction initiatives • Monitor CMS policy, state regulations, and commercial payor developments • Assess prospective expansion markets and identify payor targets, network gaps, and contracting timelines • Lead payor outreach, contract execution, and enrollment coordination for new market entry • Support enterprise-wide payor strategy initiatives led by the VP of Payor Strategy • Lead cross-functional communication, education, and process standardization • Establish and maintain SOPs for consistent execution, new site launches, and market expansions • Partner with Credentialing and Enrollment on provider participation • Report regional payor performance, risks, and strategic updates to the VP of Payor Strategy

🎯 Requisitos

• Bachelor’s degree in Healthcare Administration, Business, Finance, or a related field • 8+ years of progressive experience in managed care contracting, payor relations, or healthcare revenue cycle within a multi-site or multi-state organization • Demonstrated history of managing or leading teams, functions, or cross-functional initiatives • In-depth knowledge of commercial payor structures, Medicare Advantage, and Medicaid managed care variations across multiple states • Strong analytical skills to interpret reimbursement terms, model contract scenarios, and translate claims data into actionable strategy • Proven track record negotiating and executing complex payor contracts with measurable positive revenue impact • Proficiency with contract modeling tools, RCM systems, and analytics platforms such as Tableau or equivalent • Excellent communication and relationship-building skills across payor executives, internal leadership, and cross-functional stakeholders • Ability to manage multiple complex projects across regions with competing priorities and minimal day-to-day oversight • Experience in a PE-backed, multi-state healthcare organization, MSO, specialty medical group, or ASC environment • Preferred: familiarity with multi-state credentialing, provider enrollment, and taxonomy compliance • Preferred: knowledge of value-based care, risk arrangements, and payor quality programs • Preferred: experience with Athena Practice or comparable practice management and RCM platform • Preferred: established relationships with national and regional commercial payor contracting and network management teams

🏖️ Benefícios

• Commitment to growth, advancement, and professional development • Equal opportunity workplace • Compensation and benefits administered in accordance with applicable laws

📊 Verifique sua pontuação de currículo para esta vaga

Melhore suas chances de conseguir uma entrevista verificando sua pontuação de currículo antes de se candidatar.

Enviar Currículo