Director of Payor Relations

🔥 15 hours ago

🇺🇸 United States – Remote

⏰ Full Time

🔴 Lead

👔 Director

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Metro Vein Centers

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2008

💼 Consulting

📦 Logistics

🏥 Healthcare

Consulting • Logistics • Healthcare

Metro Vein Centers is a network of nationally-accredited outpatient vein clinics providing patient-centered diagnosis and minimally invasive treatments for varicose and spider veins. The company operates clinics across multiple U. S. states staffed by board-certified vein specialists, offering procedures such as radiofrequency and laser ablation, sclerotherapy, and Venaseal, with many treatments covered by insurance. Metro Vein Centers emphasizes state-of-the-art, ultrasound-guided care, high patient satisfaction, free evaluations, and both medical and cosmetic relief for vein disease.

📋 Description

• Own all payor relations and payor strategy activity across an assigned regional market portfolio • Serve as the single point of accountability for payor relationships, contracts, negotiations, and strategic initiatives • 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 • Maintain accurate and compliant contracts, fee schedules, amendments, and provider enrollment statuses • 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, rate impact assessments, dashboards, and KPI reporting • Develop and execute regional payor strategy aligned with growth and net revenue goals • Identify revenue improvement opportunities and lead renegotiations, rate corrections, and denial reduction initiatives • Monitor CMS policy, regulatory changes, and commercial payor developments • Assess prospective expansion markets and lead payor outreach, contract execution, and enrollment coordination • Lead cross-functional communication, education, process standardization, and SOP development • Partner with Credentialing and Enrollment on provider participation • Report regional payor performance, risks, and strategic updates to the VP of Payor Strategy

🎯 Requirements

• 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 • 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

🏖️ Benefits

• Professional development and advancement opportunities • Equal opportunity employment • Compensation and benefits administered in accordance with applicable federal, state, and local laws