Director of Payor Relations

🕒 il y a 2 mois

🇺🇸 États-Unis – Télétravail

⏰ Temps Plein

🔴 Expert

👔 Directeur

👻 Score fantôme 51%

Ce que ça veut dire : la probabilité que cette offre reste ouverte sans recrutement actif.Comment le lire : 60 % ou plus, on pense que c'est une offre fantôme. Un score plus bas est moins inquiétant.Comment on la calcule : ancienneté, republications, postes ouverts vs taille de l'équipe, rapidité de clôture, et si le salaire est indiqué.À noter : une estimation à partir de données publiques, pas un jugement sur l'entreprise. De vraies offres peuvent avoir un score élevé, alors prenez-le comme un indice, pas comme un fait.

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Metro Vein Centers

Site WebLinkedInTous les Emplois

501 - 1000 employés

Fondée en 2008

💼 Conseil

📦 Logistique

🏥 Santé

Consulting • Logistics • Healthcare

Metro Vein Centers est un réseau de cliniques veineuses ambulatoires accréditées au niveau national, offrant des diagnostics centrés sur le patient et des traitements peu invasifs pour les varices et les varicosités. L'entreprise exploite des cliniques dans plusieurs États américains, dotées de spécialistes veineux certifiés, proposant des procédures telles que l'ablation par radiofréquence et laser, la sclérothérapie et le Venaseal, dont beaucoup sont couvertes par les assurances. Metro Vein Centers insiste sur des soins guidés par échographie à la pointe de la technologie, une grande satisfaction des patients, des évaluations gratuites et un soulagement à la fois médical et esthétique des maladies veineuses.

Description

• 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

🎯 Exigences

• 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

🏖️ Avantages

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