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Years of Experience
ProfilePayor Relations Director The candidate will understand and refine the universe of payor contracting market intelligence, both private and government. Will determine and track payor financial performance and enrollment figures by geography; Oversee the collection, accuracy and relevance of this data; Apply market intelligence to inform company’s contracting, credentialing, and overall payor relations strategies. Will operates as lead point of contact for payor and provider partners; Fosters positive, cohesive, long term relations with assigned portfolio of payors. Will act as liaison between payors and cross functional teams to ensure contract obligations are met/exceeded. Will lead implementation and new payor set-up as needed. Will resolves, escalates, and/or mitigates high severity issues, requests or concerns. Will identifies strategic growth opportunities within portfolio of payors. Will negotiate both the financial terms and contractual provisions of participation agreements and amendments. Will keep the firm team abreast of current topics and market changes throughout the insurance landscape. Will develop value-added collaborations with various payors. Will be conducting and presenting analysis/recommendations to executive team and operational leadership on potential new models. Will be overseeing negotiation and/or application of the program
Qualification and Experience
The candidate should have Master’s in Health Care Management, MBA or JD. Professional certification related to managed care, healthcare finance, or health insurance. Should have progressive experience with physician groups, hospitals, healthcare management practices, payor contract negotiations, legal reviews or contract management preferred. Experience in financial analysis and reporting, and creating financial models. Consulting experience in the healthcare industry preferred. Must work well with team members, have good organization and time management skills and embody firm core Values.