Director, Payer Relations
Stellus Rx
full-time
Posted on:
Location Type: Remote
Location: Texas • United States
Visit company websiteExplore more
Job Level
About the role
- Develop comprehensive strategies to optimize relationships with payors, including negotiating contracts, rates, and terms.
- Monitor industry trends, regulatory changes, and competitor activities to inform payor negotiation strategies.
- Collaborate with senior leadership to align payor strategies with organizational goals and objectives.
- Lead negotiations with payors to secure favorable contract terms, reimbursement rates, and payment methodologies.
- Evaluate proposed contracts and amendments to ensure alignment with organizational priorities and financial targets.
- Manage contract compliance, including monitoring performance metrics, resolving disputes, and implementing corrective actions when necessary.
- Oversee the credentialing and enrollment process for healthcare providers, ensuring timely and accurate submissions to payors.
- Maintain up-to-date knowledge of credentialing requirements, regulations, and accreditation standards.
- Coordinate with internal departments (e.g., provider relations, revenue cycle) to streamline credentialing workflows and minimize delays.
- Collaborate with revenue cycle management teams to identify opportunities for improving billing processes, claims submission, and reimbursement efficiency.
- Analyze revenue cycle data and performance metrics to identify trends, root causes of denials, and opportunities for revenue enhancement.
- Implement best practices and process improvements to optimize revenue cycle performance and reduce revenue leakage.
- Cultivate and maintain strong relationships with key stakeholders at payor organizations, including executives, contracting representatives, and network managers.
- Serve as the primary point of contact for payors regarding contract negotiations, issue resolution, and strategic initiatives.
- Advocate for the organization's interests while fostering collaborative partnerships with payors to achieve mutual goals.
Requirements
- Bachelor's degree in Healthcare Administration, Business, Finance, or related field (Master's degree preferred).
- Extensive experience (5+ years) in healthcare payor relations, contract negotiation, and revenue cycle management.
- In-depth knowledge of healthcare reimbursement methodologies, including fee-for-service, value-based reimbursement, capitation, and bundled payments.
- Strong analytical skills with the ability to interpret financial data, assess contract performance, and develop actionable insights.
- Excellent communication, negotiation, and interpersonal skills, with the ability to influence stakeholders at all levels.
- Proven track record of successfully negotiating contracts, resolving complex issues, and achieving measurable results.
- Familiarity with healthcare regulations, compliance requirements, and industry standards related to payor contracting and reimbursement.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
contract negotiationrevenue cycle managementhealthcare reimbursement methodologiesfinancial data analysisperformance metrics evaluationcredentialing process managementbilling process improvementclaims submissioncontract complianceprocess improvement
Soft Skills
analytical skillscommunication skillsnegotiation skillsinterpersonal skillsinfluencing skillscollaborationproblem-solvingrelationship managementleadershipstrategic thinking