Director, Payer Strategy & Contracting

Financial Performance and Contract Analytics: - Partners with Finance to evaluate contract terms, forecast expected revenue, assess reimbursement performance, and identify potential financial risk exposure. - Uses data and analytics to identify underperformance trends, reimbursement gaps, payer payment issues, and opportunities for improvement. - Supports cost modeling, contract performance dashboards, financial impact assessments, and executive-level reporting related to payer contract performance. - Prepares and presents contract performance updates, recommendations, and executive briefings to support informed decision-making.

Payer Relationship and Stakeholder Governance: - Serves as a primary liaison with external payer contracting teams and supports productive, collaborative payer relationships. - Leads cross-functional governance related to payer performance, contract implementation, reimbursement issues, and operational barriers. - Coordinates with Revenue Cycle, Finance, Compliance, Clinical Operations, Population Health, and other internal stakeholders to ensure contract terms are implemented and operationalized effectively. - Provides internal education and guidance regarding payer contract terms, reimbursement methodologies, payment policies, and operational requirements. - Collaborates with revenue cycle teams to resolve payer payment issues, denials, reimbursement disputes, and other contract-related operational concerns.

Payer Enrollment Oversight: - Provides leadership and oversight for payer enrollment activities, including applications, revalidations, enrollment maintenance, and related payer requirements. - Manages the Payer Enrollment Specialist and ensures payer enrollment processes support organizational access, reimbursement, compliance, and operational needs. - Ensures payer enrollment activities are coordinated across applicable locations, providers, and payer programs.

Compliance, Documentation, and Regulatory Alignment: - Ensures payer agreements align with applicable federal and state regulations, including Medicaid managed care requirements, Medicare guidelines, value-based care reporting requirements, and other payer-specific obligations. - Ensures appropriate alignment of payer contracts with FQHC reimbursement methodologies and applicable grant, funding, or program requirements, where applicable. - Maintains accurate payer contract files, rate schedules, payer documentation, and related regulatory records. - Supports audits, regulatory reviews, payer inquiries, and compliance-related requests as needed.

MINIMUM EDUCATION: Bachelor's Degree (higher degree accepted) in Business, Healthcare Administration, Finance, or related field