JOB SUMMARY

 
The Director of Payor Contracting is a key leadership role responsible for developing, negotiating, and managing contracts with healthcare payors, including insurance companies, government agencies, and other third-party payors. This role requires a strategic and analytical mindset, strong communication and negotiation skills, and a deep understanding of healthcare reimbursement systems. To perform this job successfully, an individual must be able to perform each essential job duties satisfactorily. The requirements listed below are representative of the knowledge, skills, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

ESSENTIAL JOB RESPONSIBILITIES

• Lead the development and negotiation of contracts with payors to ensure favorable terms, reimbursement rates, and coverage for healthcare services provided by the organization.
• Analyze market trends, competitive benchmarks, and industry regulations to inform contract negotiations and pricing strategies.
• Collaborate with cross-functional teams, legal counsel, and executive leadership to ensure contract terms align with business objectives and compliance standards.
• Evaluate financial implications of proposed contract terms, including fee schedules, reimbursement rates, and payment models.
• Conduct cost-benefit analyses to assess the potential impact of new contracts on the organization's revenue and profitability.
• Cultivate and maintain strong relationships with payor representatives, healthcare executives, and key stakeholders to drive successful contract negotiations and maintain open communication channels.
• Address payor concerns and inquiries, resolve disputes, and ensure contract compliance over time
• Partner with Credentialing, Revenue Cycle, Finance, Legal, and Operations to ensure contract terms optimize revenue goals and EDP clinical practices and satisfy legal requirements.
• Provides clear direction to achieve goals, creating an environment that fosters team commitment and employee engagement while being resilient and flexible, and inspiring and motivating the team.
• Constantly communicates to the team, is open to opinions and feedback from team members and follows through on commitments.

OTHER JOB RESPONSIBILITIES

• Oversight of the contract analysis function.
• Oversight of the Credentialing and Enrollment functions.
• Other duties as required.

REQUIRED EDUCATION AND EXPERIENCE

• Bachelor's degree in Business Administration, Healthcare Administration, or a related field; Master's degree preferred.
• Extensive experience (typically 7 years) in healthcare contracting, payer relations, or a related role within the healthcare industry.

QUALIFICATIONS

• Excellent communication skills, both written and verbal. Ability to interact at all organizational levels.
• Demonstrated ability to solve complex problems.
• Proven ability to drive performance, metric outcomes and collaborate cross departmentally to help meet and exceed organizational goals.
• Self-starter who excels in a fast paced, data driven environment.
• Contract modeling and analytic skills.
• Ability to use business intelligence and data warehouse tools and define data relational and reporting requirements.
• Strong ability to effectively lead a team and influence others.
• Strong proficiency in Excel, Word, PowerPoint

PHYSICAL REQUIREMENTS

• Travel up to 50%
• General office activities

The above statements are intended to provide a general overview and level of work being performed by most people assigned to this job. They are not intended to be a list of all responsibilities, duties and requirements. Additional duties can be assigned as determined.

Elite Dental Partners is an Equal Opportunity Employer. We support a diverse workforce.