E01025 – Director of Payor Relations
Position Overview: The Director of Payor Relations is responsible for managing contracting efforts and the contract management team as directed by the Senior Vice President of Strategic Payor Relations. Responsibilities include ensuring contract implementation, internal education, and the resolution of billing issues not able to be addressed by the Patient Accounts team. Additional duties also include credentialing, maintaining good relations with the payors, and creating and/or distributing general communications both internally and to payors.
- Sell RCA’s services to prospective and existing payors with a focus on growing the
- Identify business opportunities with new and existing payors that can be memorialized into contractual
- Analyze contract language and reimbursement rates to ensure alignment with RCA strategic goals.
- Manage RCA’s relationships with payors and act as the primary point of contact within
- Analyze needs and strategic direction and determine opportunities to improve contract profitability to strengthen RCA’s strategic
- Maintain database of contracts, rates and key contract terms.
- Solicit information and feedback from operating departments regarding implementation and performance of contracts as
- Responsible for developing successful relationships with payor contacts and internal partners; act as liaison for resolution of problems related to reimbursement or utilization management.
- Educate internal partners about new and revised contracts and build strong working relationships across the enterprise.
- Maintains database of key contacts at all contracted
- Work with internal partners to track and report incidents to payors as contractually required and respond to payor quality of care correspondence.
Education and Experience:
- Bachelor’s degree in Business, Finance, Health Administration or related degree preferred.
- 7+ years of work experience required in a health care insurance or health care provider
- 3+ years in a management capacity.
- Demonstrated ability to deliver results and execute on business
- Financial acumen with an understanding of health insurance reimbursement methodologies.
- Strong negotiation
- Proactive strategist with ability to anticipate market changes and
- Excellent oral and written communication
- Proficient in Microsoft Office
- Ability to multi-task and shift priorities quickly and efficiently.
Creating the New and Different: The ability to generate new ideas and breakthroughs requires vision, creativity, and broad interests and knowledge.
Impact and influence: Work effectively with and through others including those whom there is no formal authority.
Business Acumen: Ability to understand budgets with a strong bottom-line mentality and understand the levers that make the biggest impact.
Work Environment: This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, and filing cabinets. The noise level in the work environment is usually moderate.
Physical Demands: While performing the duties of this position, the employee is regularly required to talk or hear. The employee frequently is required to use hands to finger, handle or feel objects, tools or controls. The employee is occasionally required to stand; walk; sit; reach with hands and arms; climb or balance; and stoop, kneel, crouch or crawl. The employee must occasionally lift and/or move objects up to 25 pounds. Specific vision abilities required by this position include close vision, distance vision, color vision, peripheral vision and the ability to adjust focus.
Travel — 10% expected travel