Director of Payer Strategy

Smile Brands•Remote, Work from Home, UNAVAILABLE

About The Position

The Director, Payer Strategy is responsible for leading Smile Brands’ payer contracting, relationship management, and payer performance initiatives. This role develops and maintains strategic payer partnerships, supports reimbursement optimization efforts, and collaborates with internal stakeholders to ensure effective implementation and management of payer agreements. The Director serves as a key leader within the Payer Strategy team, overseeing payer negotiations, contract administration, performance monitoring, and cross-functional collaboration to support organizational growth and financial objectives.

Requirements

Bachelor’s Degree in Business Administration, Finance, Healthcare Administration, Economics, or related field.
Significant experience in payer contracting, managed care, provider relations, healthcare reimbursement, or payer strategy.
Meaningful leadership and management experience.
Demonstrated experience negotiating payer contracts and managing payer relationships.
Strong understanding of healthcare and dental reimbursement methodologies, payer economics, and contract structures.
Strong analytical, financial evaluation, and problem-solving skills.
Experience developing reports, metrics, and performance monitoring tools.
Ability to manage multiple projects, priorities, and stakeholder relationships effectively.
Strong verbal, written, presentation, and interpersonal communication skills.
Proven ability to collaborate effectively within a matrixed organization.

Nice To Haves

Experience in a Dental Support Organization (DSO), dental payer environment, or multi-site healthcare organization.
MBA, MHA, or related advanced degree.
Experience with payer analytics, financial modeling, and reimbursement analysis.
Familiarity with value-based reimbursement arrangements and alternative payment models.
Strong negotiation and relationship management capabilities.
Ability to influence decisions using data-driven insights and sound business judgment.
Results-oriented with strong organizational and project management skills.
Demonstrated ability to develop high-performing teams and drive operational improvements.

Responsibilities

Lead payer contracting activities, including contract renewals, renegotiations, and network participation initiatives.
Conduct financial and operational analysis to support payer negotiations and contract recommendations.
Negotiate reimbursement rates, contract terms, and operational provisions with commercial carriers, TPAs, managed care organizations, specialty networks, and government-sponsored programs.
Ensure contract language and provisions comply with organizational standards and regulatory requirements.
Develop negotiation strategies and recommendations that balance patient access, reimbursement, and operational considerations.
Maintain awareness of upcoming renewals and develop negotiation plans to support organizational objectives.
Develop and maintain productive relationships with assigned payer organizations.
Serve as the primary point of contact for payer-related issues, escalations, and operational concerns.
Conduct regular business reviews, stewardship meetings, and performance discussions with payer partners.
Collaborate with payers to address reimbursement issues, operational challenges, and implementation activities.
Support efforts to strengthen payer partnerships and identify opportunities for mutual growth and improvement.
Monitor payer contract performance, reimbursement trends, utilization patterns, and operational metrics.
Develop reports, scorecards, and dashboards to evaluate payer performance against established goals.
Identify opportunities to improve reimbursement outcomes, payer performance, and operational efficiency.
Partner with Finance and Revenue Cycle teams to assess financial performance and contract effectiveness.
Communicate payer performance results and recommendations to senior leadership.
Partner with Revenue Cycle, Finance, Operations, Contracting & Credentialing, Fee Administration, Legal, and Clinical Leadership to support payer initiatives.
Support implementation and communication of new contracts, reimbursement changes, and payer policy updates.
Assist operational teams in understanding payer requirements, reimbursement methodologies, and contract provisions.
Participate in projects and committees that impact reimbursement, patient access, and payer performance.
Support payer-related analytics and business initiatives as needed.
Monitor payer market trends, competitive activity, and regulatory developments.
Evaluate opportunities for network expansion, participation in new payer programs, and reimbursement improvement.
Provide recommendations regarding payer opportunities, risks, and emerging market trends.
Support strategic planning efforts through payer intelligence and market research.
Lead, mentor, and develop members of the Payer Strategy team.
Establish priorities, performance expectations, and development plans.
Promote collaboration, accountability, and continuous improvement across the team.
Ensure appropriate documentation, processes, and controls are maintained.