Director of Payor Strategy

Core Clinical Partners stands at the forefront of Emergency and Hospital Medicine, delivering unparalleled services through a model that emphasizes patient-centric care and operational excellence. Our corporate values – Genuine, Accountable, Dynamic, Respectful, and Fun – are the pillars that uphold our commitment to revolutionize healthcare delivery.

The Director of Payor Strategy is responsible for shaping and executing our payor strategies as well as developing, implementing, and managing strategies to optimize payor relationships, contracts, and performance. This role requires a deep understanding of the healthcare payor landscape, excellent negotiation skills, and the ability to collaborate effectively with internal and external stakeholders.

Essential Duties:

• Develop and implement comprehensive payor strategies that align with organizational goals and objectives.
• Lead negotiations with payors to secure favorable terms and conditions, ensuring alignment with Core Clinical Partners' financial and operational goals.
• Build and maintain strong relationships with payors, fostering collaboration and addressing any issues or concerns that may arise.
• Monitor payor performance and identify opportunities for improvement. Implement corrective actions as necessary.
• Conduct market analysis to stay abreast of industry trends and changes in the payor landscape. Disseminate and understand healthcare market changes including impacts due to No Surprise Act. Provide insights and recommendations based on findings.
• Ensure all payor contracts and strategies comply with relevant laws, regulations, and standards.
• Work closely with the VP of RCM, finance, clinical operations, third-party vendors, hospital leadership, and other departments to ensure alignment and integration of payor strategies across the organization.
• Prepare and present regular reports on payor strategies, performance, and market trends to senior leadership.
• Lead and mentor a team of professionals, fostering a culture of excellence, collaboration, and continuous improvement.
• Be a champion for change, advocating for policies that enhance patient care and equitable reimbursement.
• Implement a reporting platform that is utilized as a contract repository in which reporting can be derived on key contract language data elements.
• Perform other related duties as assigned.

Skills, Knowledge, Abilities:

• Strong negotiation and communication skills.
• In-depth knowledge of healthcare payor contracts, reimbursement methodologies, and regulatory requirements.
• Ability to analyze complex data and provide strategic insights.
• Excellent project management and organizational skills.
• Proficient in Microsoft Office Suite and other relevant software.
• Strong leadership and team management skills.
• Excellent analytical and problem-solving abilities.
• In-depth knowledge of healthcare billing, coding, and reimbursement processes.
• Proficient in the use of revenue cycle management software and electronic health record (EHR) systems.
• Strong communication and interpersonal skills, with the ability to work effectively with diverse teams.
• Ability to work under pressure and manage multiple priorities.
• Collaborate with professionals internal and external to the company and across geographic locations?
• Exhibit growth mindset and team-orientated behaviors
• Navigate competing priorities and effectively work in a fast-paced environment

Education:

• Bachelor’s degree in Business Administration, Healthcare Administration, or related field preferred.
• Master’s degree in Healthcare Administration, Business, or a related field is preferred.

Experience:

• Minimum of 7-10 years of experience in healthcare payor strategy, contract negotiation, and relationship management.
• Experience with revenue cycle management systems and software.
• Experience in a leadership or management role is preferred.

This position will supervise a team as well as third-party vendors.