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Director of Payor Relations
Metro Vein Centers. Own all payor relationships, contracts, negotiations, and strategic initiatives across an assigned regional portfolio .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in managing payor relationships, contract negotiations, and strategic initiatives within the healthcare sector, with a strong focus on revenue cycle management and compliance. Proven ability to analyze reimbursement trends and develop actionable strategies to enhance financial performance.
Highest-signal resume keywords
Managed Care ContractingPayor RelationsContract NegotiationHealthcare Revenue CycleAnalytical Skills
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Contract ModelingReimbursement MethodologiesFee Schedule ManagementClaims Data InterpretationMarket Analysis
Soft Skills
Communication SkillsRelationship BuildingProject Management
Tools & Technologies
TableauRCM SystemsContract Modeling ToolsAthena Practice
Industry Keywords
Medicare AdvantageMedicaid Managed CareValue-Based CareCredentialingProvider Enrollment
Tech Stack
Tools & technologiesTableau
About the role
Key responsibilities & impact- Own all payor relationships, contracts, negotiations, and strategic initiatives across an assigned regional portfolio
- Lead negotiations with commercial, Medicare Advantage, and Medicaid managed care plans
- Maintain payor landscape knowledge, contract status, network participation, fee schedule benchmarks, and market dynamics
- Build senior-level relationships with health plan contracting and network management teams
- Keep contracts, fee schedules, amendments, and provider enrollment statuses accurate, compliant, and current
- Resolve complex payor issues including claims disputes, authorization denials, credentialing holds, payment variances, and systemic billing problems
- Manage contract modeling, reimbursement methodologies, fee schedules, and contract term dates
- Interpret contract terms and state-specific requirements into operational guidance
- Monitor payor performance, reimbursement trends, policy changes, revenue leakage, underpayments, and denial patterns
- Conduct market reviews and close network participation gaps
- Develop financial models, benchmarking analyses, rate impact assessments, dashboards, and KPI reporting
- Develop and execute regional payor strategy aligned with growth targets, expansion timelines, and net revenue goals
- Identify revenue improvement opportunities through renegotiations, rate corrections, and denial reduction initiatives
- Monitor CMS policy, state regulations, and commercial payor developments
- Assess prospective expansion markets and identify payor targets, network gaps, and contracting timelines
- Lead payor outreach, contract execution, and enrollment coordination for new market entry
- Support enterprise-wide payor strategy initiatives led by the VP of Payor Strategy
- Lead cross-functional communication, education, and process standardization
- Establish and maintain SOPs for consistent execution, new site launches, and market expansions
- Partner with Credentialing and Enrollment on provider participation
- Report regional payor performance, risks, and strategic updates to the VP of Payor Strategy
Requirements
What you’ll need- 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 within 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 to interpret reimbursement terms, model contract scenarios, and translate claims data into actionable 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 across 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
- Preferred: familiarity with multi-state credentialing, provider enrollment, and taxonomy compliance
- Preferred: knowledge of value-based care, risk arrangements, and payor quality programs
- Preferred: experience with Athena Practice or comparable practice management and RCM platform
- Preferred: established relationships with national and regional commercial payor contracting and network management teams
Benefits
Comp & perks- Commitment to growth, advancement, and professional development
- Equal opportunity workplace
- Compensation and benefits administered in accordance with applicable laws