Director of Payor Contracting & Relations

Precision Healthcare Specialists•Fort Myers, FL

62d•Hybrid

About The Position

The Director of Payor Contracting and Relations is responsible for managing payor relationships, contract negotiation, and optimization across multiple healthcare entities within the organization. This role serves as the primary liaison between the organization and commercial insurance payors, government programs, and managed care organizations to ensure favorable contract terms, accurate reimbursement, and strategic positioning in the market. Working with the SVP, the Director will develop and implement contracting strategies that align with organizational growth objectives while maximizing revenue and maintaining strong payor relationships across all business units.

Requirements

Bachelor's degree in Business Administration, Healthcare Administration, Finance, or related field required
Master's degree (MBA, MHA, or related) preferred
Minimum 7-10 years of progressive experience in payor contracting, with at least 3-5 years in a leadership role
Demonstrated experience managing contracts across multiple healthcare entities or facilities
Proven track record of successful contract negotiations resulting in favorable rate improvements
Experience in rapidly growing healthcare organizations preferred
Expert knowledge of healthcare reimbursement methodologies, including fee-for-service, capitation, value-based arrangements, and bundled payments
Deep understanding of commercial insurance, Medicare, Medicaid, and managed care contracting
Strong financial acumen with ability to analyze complex fee schedules and model financial impact
Excellent negotiation skills with demonstrated ability to achieve win-win outcomes
Proficiency in contract management systems and revenue cycle applications
Advanced Excel skills for financial modeling and data analysis
Strong understanding of healthcare regulations, compliance requirements, and legal considerations in contracting
Strategic thinking with ability to align contracting activities with organizational objectives
Exceptional analytical and problem-solving abilities
Outstanding communication and presentation skills for diverse audiences
Strong relationship-building and interpersonal skills
Ability to manage multiple priorities and complex projects simultaneously
High attention to detail and organizational skills
Collaborative leadership style with ability to influence across organizational levels

Nice To Haves

Experience with Medicaid and Medicare Advantage contract negotiations
Knowledge of value-based care models and alternative payment methodologies
Experience implementing payor contracts in new states or markets
Familiarity with credentialing processes and provider enrollment

Responsibilities

Lead contract negotiations with commercial payors, Medicare Advantage plans, Medicaid managed care organizations, and other third-party payors across multiple healthcare entities
Develop and execute comprehensive contracting strategies that support organizational financial goals and market expansion
Analyze contract proposals, fee schedules, and reimbursement methodologies to ensure optimal financial outcomes
Manage the complete contract lifecycle including drafting, negotiation, execution, implementation, and renewal processes
Coordinate with legal counsel on contract language, terms and conditions, and risk mitigation strategies
Maintain centralized contract repository and ensure all agreements are current, accessible, and properly documented
Conduct comprehensive financial modeling and analysis of proposed contract terms and reimbursement rates
Monitor contract performance metrics including reimbursement trends, denial rates, and payment accuracy
Identify opportunities for rate improvements and contract optimization across all payor relationships
Collaborate with finance team on revenue forecasting and budget planning related to payor contracts
Analyze market trends, competitor positioning, and payor network adequacy to inform negotiation strategies
Build and maintain strategic relationships with payor representatives, network managers, and key decision-makers
Serve as primary point of contact for payor-related issues, disputes, and escalations
Partner with operations leadership to address payor requirements and resolve operational challenges
Coordinate with provider relations and credentialing teams to ensure seamless provider network participation
Ensure all contracts comply with federal and state regulations, including Medicare, Medicaid, and commercial insurance requirements
Monitor regulatory changes affecting payor contracting and implement necessary adjustments
Develop and maintain policies and procedures for contract management and payor relations
Identify and mitigate contractual risks across the organization
Build, lead, and mentor a high-performing payor contracting team supporting multiple entities
Provide guidance and support to revenue cycle staff on payor contract interpretation and implementation
Develop team capabilities in contract analysis, negotiation techniques, and relationship management
Foster a collaborative culture focused on achieving optimal outcomes for the organization