Director, Payer Relations (32413)

GI Alliance; Southlake (TX); On-site; USD 120,000 - 170,000; Full time

Job summary

GI Alliance is seeking an experienced Director of Payer Relations to lead the negotiation, management, and optimization of payer contracts and reimbursement strategies across our network.

The role requires strong negotiation skills, deep knowledge of payer contract language, and the ability to analyze payer performance metrics while collaborating with clinical, operational, legal, and financial teams. Travel up to 10% is required.

Qualifications

• 5 years healthcare experience including 3 years managed care in a managed care organization operating environment.
• Experience negotiating contracts directly with payors.
• Strong knowledge of payer contract language and reimbursement concepts.
• Ability to travel up to 10% for external collaboration.

Responsibilities

• Support the Executive Director in the contractual life cycle of payer agreements, including negotiation and maintenance.
• Negotiate favorable terms and rates aligned with financial goals.
• Navigate complex payer issues related to reimbursement, authorizations, appeals, and recoupments.
• Collaborate with internal stakeholders to implement contract terms and resolve payer disputes.
• Monitor payer scorecards and market dynamics to inform strategic direction.

Skills

Payor negotiations

Payer relations management

Healthcare payer contracts knowledge

Travel readiness

Job description

GI Alliance is seeking an experienced Director of Payer Relations.

Duties of this position include, but are not limited to, the following:

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 assignedDemonstrates 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.

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