Director, Payer Relations

Paycom; Southlake (TX); On-site; USD 120,000 - 180,000; Full time

Job summary

GI Alliance in Southlake, TX is seeking an experienced Director of Payer Relations to lead the negotiation, renegotiation, and management of payer contracts. The role involves developing strong internal relationships to secure favorable terms and improve reimbursement strategies.

The candidate will bring healthcare experience (5+ years) with 3+ years in managed care, and a proven track record negotiating with payors. Travel up to 10% is required.

Qualifications

• 5 years healthcare experience, including 3 years of managed care experience in a managed care organization.
• Experience negotiating contracts directly with Payors required
• Strong payor contract knowledge required, previous payor operations experience is ideal
• Demonstrated success in working with Payors required
• Knowledgeable of healthcare provider operations
• Must be able to travel up to 10% of the time

Responsibilities

• Support Executive Director in contractual life cycle of assigned payer agreements
• Negotiate and renegotiate terms to yield favorable rates and terms
• Monitor and maintain payer contracts and related relationships
• Collaborate with operations, clinical, legal, and financial teams
• Explain contract terms to internal stakeholders and ensure compliance
• Monitor payer scorecards and reporting on performance
• Support payer dispute resolution projects and settlements
• Stay informed on payer market dynamics and reimbursement structures
• Contribute to department strategic direction and performance

Skills

Contract negotiation

Relationship management

Leadership

Strategic thinking

Travel readiness

Job description

Job DetailsJob Location: GIA Cedar Ridge Admin - Southlake, TX 76092Position Type: Full TimeJob Shift: Day

GI Alliance is seeking an experienced Director of Payer Relations.

Responsibilities

• This position is responsible for supporting the Executive Director in the contractual life cycle of assigned payer agreements via the negotiation, renegotiation, monitoring and maintenance of the paper and the development and management of associated payer contact relationships.
• This position has a strong understanding of payer contract language and supports negotiations to yield favorable contractual terms and rates in alignment with organizational business and financial needs
• The Director, Payer Relations navigates, researches, and resolves complex payer issues related, but not limited to, system loads, reimbursement, authorizations, appeals, and recoupments
• This position develops strong internal collaborative relationships with operational, clinical, legal, and financial partners to achieve efficient, effective, and long-term resolution of payer issues
• The Director, Payer Relations contributes to the overall strategic direction of the department through an understanding of payer rates and reimbursement structure and associated impact to overall financial performance, payer market dynamics and market share, and how payers acquire and are awarded new business across all financial classes
• Monitors, and maintains all managed care payer contracts in a transparent, centralized location that is accessible
• Works collaboratively with key internal and external stakeholders to coordinate communication of contract terms and provisions
• Completes education and training to various internal parties, including administrative and clinical staff, regarding new or updated contract requirements
• Reviews single case agreement terms, conditions, and rates for leadership approval
• Monitors payer scorecards and/or other reporting mechanisms to monitor overall payer performance
• Assists in payer dispute resolution projects, settlements, RCM and credentialing requested as needed
• Performs other duties and projects as assigned
• Demonstrates initiative to continually enhance understanding of the changing healthcare market by state and local regions
• Exhibit's ability to work independently and is self-directed

Qualifications

• 5 years healthcare experience, including 3 years of managed care experience in a managed care organization
• Experience negotiating contracts directly with Payors required
• Strong payor contract knowledge required, previous payor operations experience is ideal
• Demonstrated success in working with Payors required
• Knowledgeable of healthcare provider operations
• Must be able to travel up to 10% of the time

GI Alliance is an Equal Opportunity Employer. We are committed to creating an inclusive, welcoming, and equitable work environment. Our company values and celebrates the diversity of our physicians, staff and patients. We firmly believe our service is greatly enriched by our diversity of thought, experience, perspective, culture, and background.

Please Note: All job offers are contingent on the successful completion of pre-employment criminal history check.

EEO/AA-M/F/disabled/protected veteran

Qualifications