Director Payor Relations

Discover Vanderbilt University Medical Center:  Located in Nashville, Tennessee, and operating at a global crossroads of teaching, discovery, and patient care, VUMC is a community of diverse individuals who come to work each day with the simple aim of changing the world. It is a place where your expertise will be valued, your knowledge expanded, and your abilities challenged. Vanderbilt Health recognizes that diversity is essential for excellence and innovation. We are committed to an inclusive environment where everyone has the chance to thrive and where your diversity of culture, thinking, learning, and leading is sought and celebrated. It is a place where employees know they are part of something that is bigger than themselves, take exceptional pride in their work and never settle for what was good enough yesterday. Vanderbilt’s mission is to advance health and wellness through preeminent programs in patient care, education, and research.

Organization:

Managed Care Contracting

Job Summary:

The Director of Payer Relations is responsible for developing, negotiating, and managing relationships with insurance payers. This role ensures that contracts are favorable to the organization and aligns with strategic objectives. The Director of Payer Relations will work closely with various departments to optimize reimbursement rates, manage payer-related issues, and enhance overall payer performance

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Key Responsibilities:

• Ensure contracts comply with regulatory requirements and organizational policies.
• Monitor and analyze contract performance to ensure compliance and optimal financial outcomes.
• Payer Relationship Management:
• Develop and maintain strong relationships with key payer representatives.
• Address and resolve any issues or disputes with payers in a timely and effective manner.
• Serve as the primary point of contact for payer-related inquiries and issues.
• Strategic Planning and Analysis:
• Develop and implement strategies to optimize payer mix and reimbursement rates.
• Analyze market trends and payer policies to identify opportunities for improved reimbursement.
• Collaborate with senior leadership to align payer strategies with overall organizational goals.
• Collaboration and Communication:
• Work closely with revenue cycle, finance, billing, and clinical departments to ensure alignment on payer strategies and initiatives.
• Communicate effectively with internal stakeholders regarding payer policies, contract changes, and reimbursement updates.
• Provide training and support to staff on payer-related matters.
• Compliance and Risk Management:
• Ensure all payer contracts and activities comply with federal, state, and local regulations.
• Monitor changes in healthcare laws, regulations and clinical policies that impact payer contracts and relationships.
• Implement risk management strategies to mitigate potential financial and operational risks.

Qualifications:

• Education:
• Bachelor’s degree in Healthcare Administration, Business, or related field. Master’s degree preferred.
Experience:
• Minimum of 7-10 years of experience in healthcare payer relations, managed care, or a related field.

• Strong understanding of healthcare reimbursement methodologies and payer policies.
• Skills and Abilities:
• Excellent negotiation, communication, and interpersonal skills.
• Strong analytical and problem-solving abilities.
• Ability to work independently and as part of a team.
• Proficiency in Microsoft Office Suite and contract management software.

Working Conditions:

• Primarily office-based with some travel required to meet with payers and attend industry conferences.

Application Process:

Interested candidates should submit a resume and cover letter detailing their qualifications and experience.


 

Our professional administrative functions include critical supporting roles in information technology and informatics, finance, administration, legal and community affairs, human resources, communications and marketing, development, facilities, and many more.

At our growing health system, we support each other and encourage excellence among all who are part of our workforce. High-achieving employees stay at Vanderbilt Health for professional growth, appreciation of benefits, and a sense of community and purpose.

Core Accountabilities:

* Organizational Impact: Implements strategies for a sub function with direct impact to the function results.* Problem Solving/ Complexity of work: Resolves highly complex business issues that are often unprecedented that have immediate impact on own sub-function or entity and wider implications to the organization. * Breadth of Knowledge: Applies expertise within professional/technical area and uses advanced business knowledge to develop objectives.* Team Interaction: Leads a sub-function serving the organization at large or across one or more entity(s).

Core Capabilities :

Supporting Colleagues: - Develops Self and Others: Acts upon constructive feedback from all levels of the organization and initiates strategies to develop talent in others. - Builds and Maintains Relationships: Leverages relationships and insight to forecast potential future needs and influence delivery of work to exceed expectations. - Communicates Effectively: Anticipates difference audience concerns, styles and finds mutually beneficial solutions across conflicting and sensitive issues. Delivering Excellent Services: - Serves Others with Compassion: Demonstrates in-depth knowledge of broad-based issues and considers the interests of others to improve satisfaction of services. - Solves Complex Problems: Critically evaluates complex information and identifies trends/risks to make recommendations to improve processes across areas. - Offers Meaningful Advice and Support: Provides ongoing feedback and development discussions to motivate and support team members to maximize performance. Ensuring High Quality: - Performs Excellent Work: Anticipates problems or obstacles which may interfere with quality standards and develops plants to ensure area's quality standards are met. - Ensures Continuous Improvement: Routinely draws upon valuable learning from others, past experiences, and new information to determine key opportunities. - Fulfills Safety and Regulatory Requirements: Develops appropriate corrective actions for unsafe environments in order to ensure operational and safety compliance. Managing Resources Effectively: - Demonstrates Accountability: Identifies potential obstacles to goal achievement and develops solutions to address those obstacles. - Stewards Organizational Resources: Creates the appropriate systems and processes to effectively manage resources. - Makes Data Driven Decisions: Applies in-depth knowledge of data to recommend and implement new approaches to improve decision making capabilities. Fostering Innovation: - Generates New Ideas: Identifies opportunities and leads development of new initiatives that create value across areas. - Applies Technology: Creates the energy and drive for self/others to identify and leverage technology in new, innovative ways to drive greater efficiencies. - Adapts to Change: Anticipates the change process and clearly communicates impact on others/own team(s), assisting them in embracing the change.

Position Qualifications:

Responsibilities:

Certifications:

Work Experience:

Relevant Work Experience

Experience Level:

5 years

Education:

Bachelor's

Vanderbilt Health recognizes that diversity is essential for excellence and innovation. We are committed to an inclusive environment where everyone has the chance to thrive and to the principles of equal opportunity and affirmative action. EOE/AA/Women/Minority/Vets/Disabled