Director of Payor Relations

🕒 Julho 8

🇺🇸 Estados Unidos – Remoto (EUA)

⏰ Tempo Integral

🔴 Especialista

👔 Diretor

👻 Score fantasma 55%

O que significa: quão provável esta vaga está aberta sem contratação ativa.Como ler: 60% ou mais significa que achamos que é uma vaga fantasma. Pontuações mais baixas preocupam menos.Como pontuamos: tempo em aberto, republicações, vagas abertas vs tamanho do time, rapidez para fechar vagas, e se o salário está divulgado.Observação: é uma estimativa de dados públicos, não um julgamento da empresa. Vagas reais podem ter pontuação alta, então use como uma dica, não como um fato.

Candidatar-se

Encontrar Vagas Remotas Similares

Configurar Alerta de Email para Novas Vagas

📊 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

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 knowledge of the regional payor landscape, contract status, network participation, fee schedules, 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 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 to identify network participation gaps • Develop financial models, benchmarking analyses, and rate impact assessments • Develop and execute regional payor strategy aligned with enterprise growth and net revenue goals • Build dashboards and KPI reporting for contract profitability, denial trends, payor performance, and reimbursement variances • Identify revenue improvement opportunities and implement corrective plans • Monitor CMS policy, state regulatory changes, and commercial payor developments • Assess prospective expansion markets and identify payor targets and contracting timelines • Lead payor outreach, contract execution, and enrollment coordination for new market entry • Support enterprise-wide payor strategy initiatives • Lead cross-functional communication, education, and process standardization • Establish and maintain SOPs for consistent execution, 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, including interpreting reimbursement terms, modeling contract scenarios, and translating 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 • Familiarity with multi-state credentialing, provider enrollment, and taxonomy compliance in a specialty practice setting • Knowledge of value-based care, risk arrangements, and payor quality programs • Experience with Athena Practice or a comparable practice management and RCM platform • Established relationships with national and regional commercial payor contracting and network management teams

🏖️ Benefícios

• Professional development and advancement opportunities • Equal opportunity employment practices • Compensation and benefits administered in accordance with applicable laws