Director of Payer Relations – Contracting

🕒 Abril 10

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Quipt Home Medical

SiteLinkedInTodas as Vagas

501 - 1000 funcionários

🏥 Saúde

⚕️ Seguro de Saúde

💊 Farmacêutico

💰 Post-IPO Equity em 2023-04

Healthcare • Healthcare Insurance • Pharmaceuticals

Quipt Home Medical é uma líder em rápido crescimento na provisão de equipamentos respiratórios clínicos e serviços para pacientes.

Descrição

• 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.

🎯 Requisitos

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

🏖️ Benefícios

• Medical Insurance- multiple plans to choose from • Dental & Vision Insurance • Short Term Disability & Long Term Disability Options • Life Insurance • Generous PTO plan • Paid Holidays • 401K • 401K match • Competitive Pay