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Director of Payor Relations
Metro Vein Centers. Own all payor relations and payor strategy activity across an assigned regional market portfolio .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in payor relations, 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 AnalysisMarket ReviewFinancial ModelingKPI ReportingValue-Based Care KnowledgeRisk ArrangementsCredentialing Compliance
Soft Skills
Communication SkillsRelationship BuildingProject ManagementCross-Functional LeadershipProblem Solving
Tools & Technologies
RCM SystemsTableauAthena PracticeAnalytics Platforms
Certifications & Qualifications
Bachelor’s Degree in Healthcare AdministrationMaster’s Degree (MBA, MHA) Preferred
Industry Keywords
Medicare AdvantageMedicaid Managed CareMulti-State OrganizationPE-Backed HealthcareSpecialty Medical Group
Tech Stack
Tools & technologiesTableau
About the role
Key responsibilities & impact- Own all payor relations and payor strategy activity across an assigned regional market portfolio
- Serve as the single point of accountability for payor relationships, contracts, negotiations, and strategic initiatives
- 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
- Maintain accurate and compliant contracts, fee schedules, amendments, and provider enrollment statuses
- 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 to identify network participation gaps
- Develop financial models, benchmarking analyses, rate impact assessments, dashboards, and KPI reporting
- Develop and execute regional payor strategy aligned with growth and net revenue goals
- Identify revenue improvement opportunities and lead renegotiations, rate corrections, and denial reduction initiatives
- Monitor CMS policy, regulatory changes, and commercial payor developments
- Assess prospective expansion markets and lead payor outreach, contract execution, and enrollment coordination
- Lead cross-functional communication, education, process standardization, and SOP development
- 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; Master’s degree (MBA, MHA) strongly preferred
- 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 a prior role
- In-depth knowledge of commercial payor structures, Medicare Advantage, and Medicaid managed care variations across multiple states
- Strong analytical skills with the ability to interpret reimbursement terms, model contract scenarios, and translate claims data into actionable strategy
- Proven track record of negotiating and executing complex payor contracts with measurable, positive revenue impact
- Proficiency with contract modeling tools, RCM systems, and analytics platforms (Tableau or equivalent)
- Excellent communication and relationship-building skills across payor executives, internal leadership, and cross-functional stakeholders
- Demonstrated 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
- 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
Benefits
Comp & perks- Professional development and advancement opportunities
- Equal opportunity employment
- Compensation and benefits administered in accordance with applicable federal, state, and local laws