Senior Director of Payor Relations

We are seeking an experienced and dynamic and strategic leader to join our team as the Senior Director of Payor Relations. The Senior Director of Payor Relations will lead the development, negotiation, and management of payor relationships and contracts, ensuring that Monte Nido’s services are accessible to patients across all regions. This role is crucial for optimizing reimbursement strategies, navigating complex payor networks, and advancing Monte Nido’s overall financial sustainability and growth. The ideal candidate will have extensive experience in healthcare contracting, a deep understanding of managed care operations, and a strategic mindset for enhancing Monte Nido’s payor partnerships. This role will report to Monte Nido’s CFO.

Responsibilities:

• Lead the development and execution of payor contracting strategies to support Monte Nido’s business objectives and financial targets.
• Negotiate contracts with commercial, Medicaid, and Medicare payors, ensuring favorable terms and conditions that align with the organization's goals.
• Build and maintain strong relationships with payors, fostering partnerships that support service accessibility and optimized reimbursement models.
• Collaborate with internal stakeholders, including clinical, operational, and financial teams, to assess the impact of payor strategies and improve service offerings.
• Analyze reimbursement trends, market data, and payor mix to identify opportunities for growth and revenue maximization.
• Ensure compliance with all contractual, regulatory, and accreditation requirements, including the integration of value-based care initiatives where appropriate.
• Serve as a subject matter expert in payor policy changes, reimbursement methodologies, and healthcare regulations that impact Monte Nido’s operations.
• Lead a team of contracting professionals, providing guidance, mentorship, and support to achieve department and organizational goals.
• Oversee the provider enrollment process, ensuring timely and accurate credentialing and recredentialing of clinicians and facilities with payors.
• Develop and implement innovative strategies for increasing the organization’s network participation and coverage expansion.
• Monitor the financial performance of contracts and make recommendations for improvements or renegotiations.
• Participate in revenue cycle optimization efforts, collaborating with billing and finance teams to enhance reimbursement efficiencies.

Qualifications:

Bachelor's degree in Business Administration, Healthcare Administration, Finance, or related field required; Master's degree preferred.

7-10 + years of progressive experience in healthcare payor contracting, revenue cycle management, or related areas, with a focus on strategic planning and negotiation.

Strong understanding of healthcare reimbursement methodologies, including Medicare, Medicaid, commercial payors, and managed care organizations.

Demonstrated track record of successful payor contract negotiations and revenue optimization initiatives.

Exceptional analytical skills with proficiency in data analysis, financial modeling, and forecasting techniques.

Excellent communication and interpersonal skills, with the ability to build rapport with internal and external stakeholders at all levels.

Proven leadership experience with the ability to lead cross-functional teams, drive results, and foster a culture of collaboration and innovation.

Knowledge of healthcare compliance regulations, HIPAA, and other relevant regulatory requirements.