What are the responsibilities and job description for the Director of Payer Management position at Access Home Care Solutions?
Job Title: Director of Payer Management
Location: Slidell Louisiana (Hybrid/Remote options available)
Employment Type: Part-Time, Full-Time, Executive Leadership Team
Position Overview
The Director of Payer Management will lead strategic payer relations, contract negotiations, and reimbursement optimization across multiple states, with a strong emphasis on Anthem Blue Cross Blue Shield policies and compliance. This role ensures alignment between payer requirements, clinical operations, and financial performance, while fostering collaborative relationships with insurers and internal teams.
Key Responsibilities
- Contract Strategy & Negotiation
- Lead negotiations with Anthem and other major payers to secure favorable reimbursement terms.
- Interpret payer policies (including implantable pain pump and home infusion therapy guidelines) and translate them into operational workflows.
- Monitor contract performance and resolve disputes or underpayments.
- Compliance & Policy Oversight
- Ensure adherence to state and federal regulations, including CMS and payer-specific billing requirements.
- Maintain up-to-date knowledge of Anthem Wisconsin’s medical necessity criteria, coding standards, and infusion therapy billing guidelines.
- Develop internal compliance protocols and staff training programs.
- Revenue Cycle Optimization
- Oversee claims submission, denial management, and appeals processes.
- Partner with finance teams to forecast reimbursement trends and identify opportunities for revenue growth.
- Implement payer-specific billing strategies for complex therapies (e.g., implantable pain pumps, intrathecal infusion).
- Stakeholder Engagement
- Act as the primary liaison between clinical teams, finance, and payer representatives.
- Provide executive-level reporting on payer performance, reimbursement trends, and compliance risks.
- Collaborate with providers to align clinical documentation with payer requirements.
Qualifications
- Bachelor’s degree in Healthcare Administration, Finance, or related field (Master’s preferred).
- 7 years of experience in payer relations, revenue cycle management, or healthcare compliance. Experience can trump education.
- Direct experience with Anthem Blue Cross Blue Shield policies and multi-state payer management.
- Strong knowledge of HCPCS, CPT, ICD-10 coding, and infusion therapy or ancillary billing.
- Proven track record in contract negotiation and dispute resolution.
- Excellent leadership, communication, and analytical skills.
Preferred Skills
- Expertise in implantable pain pump therapy and home infusion billing.
- Familiarity with Wisconsin-specific Anthem guidelines and Medicaid crossover policies.
- Ability to leverage technology for workflow optimization (e.g., EMR, claims management software).
- Strategic mindset with the ability to balance compliance rigor and operational efficiency.
Compensation & Benefits
- Competitive executive salary with performance-based incentives.
- Comprehensive health, dental, and vision coverage.
- Professional development and continuing education support.
- Flexible work arrangements (remote/hybrid).
Job Types: Full-time, Part-time
Pay: $50,000.00 - $100,000.00 per year
Expected hours: 20 – 40 per week
Benefits:
- Dental insurance
- Health insurance
- Vision insurance
Work Location: Hybrid remote in Slidell, LA 70458
Salary : $50,000 - $100,000