Director of Payer Relations – Contracting

🕒 April 10

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Quipt Home Medical

WebsiteLinkedInAll Job Openings

501 - 1000 employees

🏥 Healthcare

⚕️ Healthcare Insurance

💊 Pharmaceuticals

💰 Post-IPO Equity on 2023-04

Healthcare • Healthcare Insurance • Pharmaceuticals

Quipt Home Medical is a rapidly growing leader in the provision of clinical respiratory equipment and service to patients. The company specializes in products like respiratory devices, power mobility solutions, home ventilation systems, durable medical equipment, CPAP/BiPAP machines, and oxygen therapy. Guided by the tagline "exceeding expectations, enriching lives," Quipt is dedicated to improving patient care in the healthcare sector.

📋 Description

• 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.

🎯 Requirements

• 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.

🏖️ Benefits

• 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