Director of Payor Relations

Job description

The Director of Payor Relations leads administration of contracts with managed care payors, ensuring favorable reimbursement terms and regulatory compliance. They analyze contract performance, model reimbursement structures, and oversee resolution of claims issues such as denials and underpayments to maximize revenue and minimize financial risk. The role also provides collaboration across functions to align payor strategies with organizational goals. Summary of Essential Job Functions: The key responsibilities of the Director of Payor Relations include but not limited to: Duties and Responsibilities - Utilize contract management between the healthcare system and managed care payors, including commercial insurers and government programs. - Review applications and pipeline. - Work within record portals. - Evaluate new and existing agreements, modeling reimbursement structures, and determining the financial and operational feasibility of proposed contract terms. - Analyze contract performance by reviewing reimbursement rates, denial trends, and payor behavior; recommend strategic modifications to maximize revenue, improve contract yield, and minimize financial risk to the organization...