Director, Payer Relations

GI Alliance is seeking an experienced Director of Payer Relations.

Duties of this position include, but are not limited to, the following

Responsibilities

• This position is responsible for supporting the Executive Director in the contractual life cycle of assigned payer agreements via the negotiation, renegotiation, monitoring and maintenance of the paper and the development and management of associated payer contact relationships.
• This position has a strong understanding of payer contract language and supports negotiations to yield favorable contractual terms and rates in alignment with organizational business and financial needs
• The Director, Payer Relations navigates, researches, and resolves complex payer issues related, but not limited to, system loads, reimbursement, authorizations, appeals, and recoupments
• This position develops strong internal collaborative relationships with operational, clinical, legal, and financial partners to achieve efficient, effective, and long-term resolution of payer issues
• The Director, Payer Relations contributes to the overall strategic direction of the department through an understanding of payer rates and reimbursement structure and associated impact to overall financial performance, payer market dynamics and market share, and how payers acquire and are awarded new business across all financial classes
• Monitors, and maintains all managed care payer contracts in a transparent, centralized location that is accessible
• Works collaboratively with key internal and external stakeholders to coordinate communication of contract terms and provisions
• Completes education and training to various internal parties, including administrative and clinical staff, regarding new or updated contract requirements
• Reviews single case agreement terms, conditions, and rates for leadership approval
• Monitors payer scorecards and/or other reporting mechanisms to monitor overall payer performance
• Assists in payer dispute re