Senior Director, Managed Care Contracting

Lumexa Imaging is one of the country's largest providers of outpatient medical imaging. With over 5,000 team members and more than 185 outpatient imaging centers across 13 states, our team conducts more than 4 million outpatient studies annually. We are the partner of choice for health systems and radiologists, delivering best-in-class clinical excellence, operations, and state-of-the-art technology across our platform.

The Senior Director, Managed Care Contracting for Lumexa Imaging provides strategic leadership for the negotiation, execution, and administration of managed care payer agreements to support the organization's financial and operational objectives. This role oversees complex contract negotiations, evaluates contract language, collaborates with internal and external legal counsel, collaborates cross-functionally to develop negotiation strategies and resolve contract-related issues, and ensures timely implementation and communication of contractual terms. The Senior Director also drives continuous improvement of contracting processes, provides subject matter expertise and guidance to internal stakeholders, and leads special projects and initiatives that enhance the effectiveness of the managed care contracting function.

Essential Duties and Responsibilities:

• Establish, build and maintain positive working relationships with payer representatives and leadership, and serve as the primary relationship manager with these individuals within assigned geographies and/or projects.
• For geographies or partner companies that are part of a joint venture relationship, collaborate with the joint venture managed care and other colleagues to accomplish the joint managed care contracting and operational targets.
• Lead the process of negotiation and execution of contracts with managed care payers and other third parties, within financial and language parameters established by the Managed Care Department leadership, including working directly to complete negotiations and execute contracts
• Collaborate with internal and external legal counsel to review, evaluate and document new and existing payer contract language compared to department language standards and regulatory language
• Perform ad hoc contract language review/analysis
• Serve as an internal resource for responding to payer contract language questions/requests
• Work with financial analysts and other department/company team members to prepare appropriate data/analysis for negotiations and for trended claim/operational issues
• Develop and provide guidance for other department team members for managing the planning process for contract negotiations and renewals, including assessment of historical performance and opportunities
• Ensure completion of contracting for acquired/new facilities and practices
• Manage resolution of contract-related claims and operational issues by proactively researching the issues and working with both internal and external customers and/or through collaboration with the Managed Care Operations Director and/or the revenue cycle team.
• Ensure new and revised contract terms are communicated to internal customers
• Develop and maintain department tracking documents
• Manage special projects as required
• Other duties as assigned

Education & Experience

• Bachelor's degree in Business Administration, Healthcare Administration, Finance, Law, or a related field required.
• Master's degree in Business Administration (MBA), Healthcare Administration (MHA), Public Health (MPH), or Juris Doctor (JD) preferred.
• Minimum of 10 years of progressively responsible experience in managed care contracting, payer relations, or healthcare reimbursement, including extensive experience negotiating complex payer agreements.
• Minimum of 5 years of leadership experience with responsibility for managing teams, projects, and organizational initiatives.
• Experience working with hospitals, physician organizations, integrated delivery systems, or large multi-specialty healthcare organizations preferred.
• Demonstrated success developing and implementing contracting strategies that improve reimbursement, operational performance, and organizational outcomes.

Knowledge, Skills & Abilities

• Expert knowledge of managed care contracting principles, payer reimbursement methodologies, and healthcare payment models, including fee-for-service, value-based reimbursement, and alternative payment arrangements.
• Comprehensive understanding of commercial, Medicare Advantage, Medicaid managed care, and other third-party payer contracting practices.
• Strong knowledge of healthcare regulatory requirements affecting managed care contracting, reimbursement, and compliance.
• Advanced contract negotiation, drafting, interpretation, and contract language analysis skills.
• Exceptional financial and analytical skills with the ability to evaluate reimbursement methodologies, identify trends, and develop data-driven negotiation strategies.
• Demonstrated ability to lead complex negotiations and influence internal and external stakeholders to achieve favorable outcomes.
• Strong strategic planning, project management, and organizational skills with the ability to manage multiple priorities and deadlines.
• Excellent written, verbal, and presentation communication skills.
• Proven ability to build collaborative relationships across executive leadership, operations, finance, legal, revenue cycle, and clinical teams.
• Strong leadership, coaching, and team development skills with experience fostering a high-performing, collaborative work environment.
• Ability to exercise sound judgment, maintain confidentiality, and make informed decisions in complex or sensitive situations.
• Proficiency with Microsoft Office applications, contract management systems, and healthcare financial and claims reporting tools.

Lumexa Imaging provides a competitive compensation program to attract, retain, and motivate a high-performance workforce.

Lumexa Imaging is an equal opportunity employer.

Originally posted on Himalayas