Director of Payor Relations

Metro Vein Centers

About The Position

The Director of Payor Relations is a senior individual contributor responsible for all payor relationships, contracts, negotiations, and strategy across an assigned regional portfolio in Metro Vein Centers’ multi-state, multi-TIN network. The role has substantial autonomy and is accountable for outcomes across payors, markets, and clinic locations while remaining aligned with enterprise objectives. The Director owns the regional contract lifecycle, including market research, relationship management, contract interpretation, fee schedule maintenance, renegotiations, issue resolution, and communication of reimbursement requirements to Revenue Cycle, Finance, Credentialing, and Operations. The position evaluates the regional payor landscape, identifies revenue opportunities and risks, and develops strategies to grow and protect net revenue across active and expansion markets. Market assignments are based on organizational needs and candidate experience. The role also supports market expansion by assessing payor landscapes, establishing network participation, and coordinating contracting and enrollment for new clinic launches. It leads regional cross-functional communication and process standardization and regularly reports regional performance, risks, and recommendations to the VP of Payor Strategy.

Requirements

Bachelor’s degree in Healthcare Administration, Business, Finance, or a related field.
8+ years of progressive experience in managed care contracting, payor relations, or healthcare revenue cycle in a multi-site or multi-state organization.
Demonstrated history of managing or leading teams, functions, or cross-functional initiatives.
In-depth knowledge of commercial payor structures, Medicare Advantage, and Medicaid managed care variations across multiple states.
Strong analytical skills, including interpreting reimbursement terms, modeling contract scenarios, and translating claims data into strategy.
Proven track record negotiating and executing complex payor contracts with measurable positive revenue impact.
Proficiency with contract modeling tools, RCM systems, and analytics platforms such as Tableau or equivalent.
Excellent communication and relationship-building skills with payor executives, internal leadership, and cross-functional stakeholders.
Ability to manage multiple complex projects across regions with competing priorities and minimal day-to-day oversight.
Experience in a PE-backed, multi-state healthcare organization, MSO, specialty medical group, or ASC environment.

Nice To Haves

Master’s degree (MBA or MHA) is strongly preferred.
Familiarity with multi-state credentialing, provider enrollment, and taxonomy compliance in a specialty practice setting.
Knowledge of value-based care, risk arrangements, and payor quality programs.
Experience with Athena Practice or a comparable practice management and RCM platform.
Established relationships with national and regional commercial payor contracting and network management teams.

Responsibilities

Own payor relationships, contracts, negotiations, and strategic initiatives across the assigned regional portfolio.
Lead negotiations with commercial, Medicare Advantage, and Medicaid managed care plans to secure favorable rates and terms.
Maintain current information on regional payors, contract status, network participation, fee schedule benchmarks, and market dynamics.
Build and maintain senior-level relationships with health plan contracting and network management teams.
Keep regional contracts, fee schedules, amendments, and provider enrollment statuses accurate, compliant, and current in contract management systems.
Act as the regional escalation point for claims disputes, authorization denials, credentialing holds, payment variances, and systemic billing problems.
Manage contract modeling and updates to reimbursement methodologies, fee schedules, and contract term dates.
Interpret contract terms, reimbursement methodologies, and state-specific requirements and translate them into operational guidance.
Monitor payor performance, reimbursement trends, and policy changes; identify revenue leakage, underpayments, and systemic denial patterns.
Review payor relationships to identify network participation gaps and ensure applicable plans and product lines are active.
Develop financial models, benchmarks, and rate impact assessments for negotiations and executive reporting.
Develop and execute regional payor strategy aligned with enterprise growth targets, expansion timelines, and net revenue goals.
Create and maintain regional dashboards and KPI reporting for profitability, denial trends, payor performance, and reimbursement variances.
Identify revenue improvement opportunities and develop plans involving renegotiations, rate corrections, and denial reduction.
Monitor CMS policy, state regulatory changes, and commercial payor developments and proactively communicate material changes to leadership.
Assess payor landscapes in prospective expansion markets and identify network gaps, payor targets, and contracting timelines for clinic launches.
Lead payor outreach, contract execution, and enrollment coordination for new market entry in partnership with Credentialing and Operations.
Support enterprise-wide payor strategy initiatives led by the VP of Payor Strategy.
Lead regional cross-functional communication, education, and process standardization related to payor requirements and contract interpretation.
Establish and maintain SOPs for consistent execution, new site launches, and market expansions.
Partner with Credentialing and Enrollment to support provider participation across regional payors and clinic locations.
Regularly communicate regional payor performance, risks, and strategic updates with data and recommendations to the VP of Payor Strategy.