Director of Payor Relations

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Metro Vein Centers

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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

• Serve as the single point of accountability for all payor relationships, contracts, negotiations, and strategic initiatives across an assigned regional portfolio, with full ownership of outcomes across every payor, market, and clinic location within that region. • Lead payor contract negotiations across all commercial, Medicare Advantage, and Medicaid managed care plans within the assigned region, securing favorable rates and terms aligned with organizational benchmarks. • Maintain a current and comprehensive understanding of the regional payor landscape, including plan relationships, contract status, network participation, fee schedule benchmarks, and market-specific dynamics. • Build and maintain senior-level relationships with health plan contracting and network management teams operating within the region. • Ensure all regional payor contracts, fee schedules, amendments, and provider enrollment statuses are accurate, compliant, and up to date within the organization’s contract management systems. • Serve as the regional escalation point for complex payor issues, including claims disputes, authorization denials, credentialing holds, payment variances, and systemic billing problems. • Own the full contract management and modeling function for the region, including timely updates to reimbursement methodologies, fee schedules, and contract term dates.

🎯 Anforderungen

• Bachelor’s degree in Healthcare Administration, Business, Finance, or a related field; Master’s degree (MBA, MHA) strongly preferred. • 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 a prior role. • In-depth knowledge of commercial payor structures, Medicare Advantage, and Medicaid managed care variations across multiple states. • Strong analytical skills with the ability to interpret reimbursement terms, model contract scenarios, and translate claims data into actionable strategy. • Proven track record of negotiating and executing complex payor contracts with measurable, positive revenue impact. • Proficiency with contract modeling tools, RCM systems, and analytics platforms (Tableau or equivalent). • Excellent communication and relationship-building skills across payor executives, internal leadership, and cross-functional stakeholders. • Demonstrated 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.

🏖️ Vorteile

• Health insurance • 401(k) matching • Flexible work hours • Paid time off • Professional development opportunities