Payor Relations & Network Mgmt Director

RAYUS Radiology•St. Louis Park, MN

2d•$125,000 - $175,000•Onsite

About The Position

RAYUS Radiology is looking for a Director of Payor Relations to join their team. This role is responsible for the development, implementation, and ongoing management of Payor and Direct to Employer contracts across RAYUS Radiology. The position is critical in supporting optimal reimbursement, maintaining RAYUS Radiology's competitive position, and fostering strong relationships with payor organizations. The Director, Payor Relations works collaboratively with internal stakeholders and external partners to support the financial and operational objectives of RAYUS Radiology and its affiliates as related to Payor Relations activities. This is a full-time position working Monday through Friday, corporate business hours.

Requirements

High School Diploma, or equivalent
Bachelor's degree in finance, accounting, or a related field, or the equivalent in relevant and applicable experience
Seven (7) years' medical business office experience including knowledge of various payers; i.e. HMO's, PPO's, TPA's Workers' Compensation carriers, Managed Care Plans Commercial/Indemnity carriers, Auto carriers, etc.
Five (5) years' in data-driven decision making to achieve business goals experience
Demonstrated experience in negotiating and managing complex payor contracts.
Experience with government payers, ACO contracting, coverage policy, oncology specialty pharmacy, employer group contracting, health system contracting, GPO contracting, and/or health economics
Experience in generating and analyzing financial reports
Proficiency in Microsoft Office suite including Word, Excel, Outlook, PowerPoint, Access and SharePoint
Some travel is required between sites; a reliable means of transportation is required.
Valid driver's license and proof of current insurance is required for the team member to personally drive a vehicle for company business (regardless of whether it's a company or personal vehicle)

Nice To Haves

Bachelor's degree in Finance or related field.

Responsibilities

Negotiate contractual and reimbursement terms with market payors, accountable care organizations and employer groups for all services rendered by RAYUS entities.
Amend existing agreements to include services not currently under contract and/or new services, facilities, etc.
Participate in system strategic initiatives impacting select payors, as needed.
Collaborate with the RAYUS Legal Team on contract language in order to mitigate risk, assure legal/regulatory compliance and obtain favorable terms.
Inform and assist in pricing strategies to maintain RAYUS' competitiveness in its regional marketplaces in order to generate appropriate margins.
Timely notify Market Leadership, CFO and VP, Payor Relations of contract renewal dates.
Monitor financial outcomes of assigned payor contracts, in collaboration with Finance and Revenue Cycle Management, to ensure reimbursement aligns with negotiated terms.
Identify reimbursement variances, underpayments, denials, and utilization trends that indicate contract-level risk or revenue leakage.
Recommend corrective actions, including contract amendments, escalations, or renegotiation strategies based on contract outcomes.
Serve as escalation point for complex payor issues requiring contractual interpretation or resolution.
Partner with Finance, Accounting, Analytics, and RCM to refine contract reporting, modeling, and forecasting.
Support Market Leadership by addressing contract-related barriers to patient access, service expansion, or operational efficiency.
Establish and maintain relationships with payors and serve as a point of contact for all aspects of the relationship.
Establish, promote, and maintain relationships for assigned payors in support of payor relations objectives.
Field questions and provide answers or ensure appropriate team members follow up effectively.
Provide education on new agreements as they affect stakeholders via written communications or presentations as needed; anticipate and address CFO, Finance and Market Leadership needs for information resulting from new or modified agreements.
Attend conferences, participate in professional organizations, and/or read publications to update knowledge of trends and product development in the field.
Develop and maintain ongoing interactions with appropriate Market team members and management regarding payor contracting.
Interact with the Markets and RCM to identify payer trends requiring action or escalation.
Assist Business Development with market intelligence for new markets and acquisitions.
Effectively and professionally represent RAYUS Radiology.
Facilitate the approval and signature process for contracts, single case agreements and settlements.
Leverage transparency data to assure negotiated rates and rate requests are competitive.
Stay informed of product developments and market pricing for competitors in an effort to support.
Other Duties and Projects as Assigned