Director of Payor Relations

Position Overview

The Director of Payor Relations is a senior individual contributor responsible for owning all payor relations and payor strategy activity across an assigned regional market portfolio within Metro Vein Centers’ multi-state, multi-TIN network. This individual is the single point of accountability for every payor relationship, contract, negotiation, and strategic initiative within their region—operating with a high degree of autonomy while staying aligned with enterprise objectives.

The Director owns the full lifecycle of payor contract management within their region: market research, building relationships with payors, interpreting contract terms, maintaining fee schedules, driving renegotiations, resolving payor issues, and translating complex reimbursement requirements into clear operational guidance for Revenue Cycle, Finance, Credentialing, and Operations. On the strategy side, this role is responsible for assessing the regional payor landscape, identifying revenue opportunities and risks, and developing the forward-looking plan to grow and protect net revenue across all active and expansion markets as assigned.

Market assignments will be determined based on organizational need and candidate experience. The ideal candidate brings deep managed care contracting expertise, a history of leading cross-functional initiatives, and the strategic fluency to thrive in a PE-backed, high-growth specialty practice environment.

How You’ll Make a Difference

Regional Payor Ownership

• Serve as the single point of accountability for all payor relationships, contracts, negotiations, and strategic initiatives across an assigned regional portfolio, with full ownership of outcomes across every payor, market, and clinic location within that region.
• Lead payor contract negotiations across all commercial, Medicare Advantage, and Medicaid managed care plans within the assigned region, securing favorable rates and terms aligned with organizational benchmarks.
• Maintain a current and comprehensive understanding of the regional payor landscape, including plan relationships, contract status, network participation, fee schedule benchmarks, and market-specific dynamics.
• Build and maintain senior-level relationships with health plan contracting and network management teams operating within the region.
• Ensure all regional payor contracts, fee schedules, amendments, and provider enrollment statuses are accurate, compliant, and up to date within the organization’s contract management systems.
• Serve as the regional escalation point for complex payor issues, including claims disputes, authorization denials, credentialing holds, payment variances, and systemic billing problems.

Contract Management

• Own the full contract management and modeling function for the region, including timely updates to reimbursement methodologies, fee schedules, and contract term dates.
• Interpret payor contract terms, reimbursement methodologies, and state-specific requirements, translating them into standardized, scalable operational guidance for consistent execution across markets.
• Monitor payor performance, reimbursement trends, and policy changes across the region; proactively identify revenue leakage, underpayments, and systemic denial patterns before they impact revenue.
• Conduct regular market reviews across current payor relationships to identify and close network participation gaps, ensuring all applicable plans and product lines are active for each contracted payor.
• Develop and maintain financial models, benchmarking analyses, and rate impact assessments to support regional negotiations and executive reporting.

Payor Strategy & Performance

• Develop and execute a regional payor strategy aligned with enterprise growth targets, expansion timelines, and net revenue goals.
• Build and maintain regional dashboards and KPI reporting to track contract profitability, denial trends, payor performance, and reimbursement variances.
• Identify revenue improvement opportunities within the region and develop actionable plans to close gaps, including contract renegotiations, rate corrections, and denial reduction initiatives.
• Stay current on CMS policy, state-specific regulatory changes, and commercial payor developments that could impact the regional portfolio; communicate material changes to leadership proactively.

Market Expansion

• Assess the payor landscape in prospective expansion markets within or adjacent to the assigned region; identify network gaps, key payor targets, and contracting timelines needed to support de novo clinic launches.
• Lead payor outreach, contract execution, and enrollment coordination for new market entry within the region, working closely with Credentialing and Operations to ensure launch readiness.
• Support enterprise-wide payor strategy initiatives led by the VP of Payor Strategy as needed.

Cross-Functional & Operational Leadership

• Lead cross-functional communication, education, and process standardization related to payor requirements, contract interpretation, and operational best practices across the region.
• Establish and maintain SOPs to support consistent execution, new site launches, and market expansions within the assigned regional portfolio.
• Partner with Credentialing and Enrollment to ensure seamless provider participation across all payors and clinic locations within the region.
• Communicate regional payor performance, risks, and strategic updates to the VP of Payor Strategy on a regular cadence, with clear data and recommendations.

Required Education & Experience

• 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.

Preferred Experience

• 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.

Originally posted on Himalayas