We are seeking a Director of Payor Contracting with expertise in fee-for-service models to lead and manage the negotiation and administration of contracts with payers and providers. This individual will be responsible for ensuring alignment between both parties and driving favorable terms to support organizational goals. With a blend of technical and strategic expertise, this role will involve contract negotiation, data analysis, and collaboration with cross-functional teams to optimize reimbursement strategies.
Key Responsibilities:
- Lead the negotiation and management of payor contracts with a focus on fee-for-service models.
- Collaborate with both payers and providers to ensure alignment on reimbursement terms and conditions.
- Analyze contract performance and identify areas for optimization to ensure cost-effective outcomes.
- Develop and maintain detailed financial models to forecast contract performance and impact.
- Work with internal stakeholders to implement contract terms, ensuring compliance with policies and regulations.
- Provide technical support in contract analysis, utilizing data to inform decision-making and strategy.
- Monitor industry trends and payer/provider policies to ensure the company's contracts remain competitive.
- Resolve issues related to contract interpretation and payment discrepancies.
Qualifications:
- 7-10 years of experience in payor contracting, with a focus on fee-for-service models.
- Strong understanding of both payer and provider contracting environments.
- Technical proficiency in data analysis tools and contract management systems.
- Experience working with cross-functional teams, including finance, legal, and clinical departments.
- Proven ability to negotiate complex contracts and manage relationships with payers and providers.
- Strong problem-solving and analytical skills with attention to detail.
- Knowledge of healthcare regulations and reimbursement methodologies.
Skills and Expertise:
- Proficient in contract analysis and financial modeling.
- Strong technical skills, including familiarity with SQL, Excel, and other data analysis tools.
- Excellent communication and negotiation skills, with the ability to interact with both technical and non-technical stakeholders.
- Ability to understand and interpret complex contract language and reimbursement structures.
- Ability to work independently and lead projects, managing multiple priorities in a fast-paced environment.
