Director of Payor Relations

🕒 vor 18 Tagen

🇺🇸 Vereinigte Staaten – Remote

⏰ Vollzeit

🔴 Experte

👔 Direktor

👻 Geisterscore 10%

Was es bedeutet: die Wahrscheinlichkeit, dass für diese Stelle niemand wirklich einstellt.So liest du es: 60 % oder höher heißt, wir halten das für einen Geisterjob. Niedrigere Werte sind weniger bedenklich.Warum dieser Wert:

• Seit 19 Tagen offen.
• Stellen bei diesem Unternehmen werden meist in 21 Tagen besetzt.
• Kein Gehalt angegeben.

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Metro Vein Centers

WebsiteLinkedInAlle Stellen

501 - 1000 Mitarbeiter

Gegründet 2008

💼 Beratung

📦 Logistik

🏥 Gesundheitswesen

Consulting • Logistics • Healthcare

Die Metro Vein Centers sind ein Netzwerk national akkreditierter ambulanter Venenkliniken, die patientenorientierte Diagnosen und minimalinvasive Behandlungen für Krampfadern und Besenreiser anbieten. Das Unternehmen betreibt Kliniken in mehreren US-Bundesstaaten, die von zertifizierten Venenspezialisten geleitet werden und Verfahren wie Radiofrequenz- und Laserablation, Sklerotherapie und Venaseal anbieten, wobei viele Behandlungen von der Versicherung abgedeckt werden. Metro Vein Centers legt Wert auf modernste, ultraschallgeführte Behandlungen, hohe Patientenzufriedenheit, kostenlose Anamnese sowie sowohl medizinische als auch kosmetische Erleichterung bei Venenerkrankungen.

Beschreibung

• 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

🎯 Anforderungen

• 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

🏖️ Vorteile

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

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