Director Payor Strategy

Overview

The Director of Payor Strategy is a leadership role responsible for developing, directing and executing managed care payor contracts to optimize reimbursement, enhance payor relationships, and support overall financial and operational goals. This individual helps lead negotiations for Commercial, Medicare and Medicaid lines of business for hospitals, physicians and ancillary providers, ensuring alignment with organizational objectives and compliance with regulatory requirements.

The role requires deep knowledge of payor contracting, including contract language, reimbursement methodologies and models, value-based care arrangements and market dynamics. This position works cross functionally with finance, revenue cycle, legal and clinical leadership to drive strategic initiatives to enhance organizational performance.

• Assist in developing and managing a portfolio of payor contracts that optimize organization revenue and margin
• Assist in developing and implementing the strategic plan for payor negotiations
• Participate in negotiations and manage complex contracts with Commercial, Medicare Advantage, Medicaid and other payor entities, including Fee-for-Service and Value-Based Payment arrangements
• Build and maintain strong relationships with payor representatives to foster collaboration, resolve disputes, and enhance partnership opportunities
• Coordinate financial analysis of payor contract performance and modeling projections based on alternate contract agreements with payors, adverse trends, etc., and make appropriate recommendations or conclusions
• Analyze contract data including financial modeling to identify contract and operational issues and provide feedback for contract renewals, negotiations and/or termination analysis
• Collaborate with legal and compliance to ensure payor contracts meet all regulatory and legal standards
• Oversee the development of contract terms, amendments and renewals ensuring alignment with changing payor trends and organizational changes
• Assist in developing and executing effective communication plans with both internal and external stakeholders related to payor relationships, negotiations, organizational contractual obligations, and developments in the managed care marketplace
• Direct value-based reimbursement opportunities that strengthen payor partnerships and patient volumes
• Serve as an advisor to executive leadership, providing insight into market dynamics, payor behavior and reimbursement trends
• Monitor payor policy changes and healthcare legislation for potential impacts on our health system

Bachelor of Science in Healthcare Administration, Business or similar discipline required.

• 7 – 10 years previous experience working in a payor and/or provider contracting or reimbursement environment.
• Minimum 4 years in a leadership capacity.

• Highly developed communication and organizational skills
• Significant knowledge of contractual, administrative, health insurance and operational issues related to managed care organizations, hospitals, physician groups, ancillary providers and health insurance benefit plan designs
• Knowledge of State and Federal Programs such as Medicaid and Medicare
• Proven and extensive contracting technical skills; negotiation skills, contract preparation and implementation, financial analysis, and rate proposal development, and in-depth knowledge of various reimbursement methodologies
• Experience with Fee for Service, Risk and Value Based Contracts for Commercial, Medicare Advantage, Medicaid, and Exchange products.