What are the responsibilities and job description for the Regulatory and Contracting Manager position at KLR Executive Search Group LLC?
KLR Executive Search Group is proud to partner with Reliable Respiratory (www.reliablerespiratory.com) to identify their newly created Regulatory and Contracting position.
Based in Norwood, MA, Reliable Respiratory is one of the United States leading independently owned home respiratory and specialty medical equipment providers. Reliable provides the highest quality level of service for patients in need of respiratory, diabetes, urology, and maternity support throughout New England. Equipment provided includes CPAPs, BiPAPs, AutoPAPs, nebulizers, oxygen equipment, ventilators, CGM devices, insulin pumps, and breast pumps.
Reporting directly to the CFO, the Regulatory and Contracting Manager will provide oversight to ensure company-wide accordance with federal, state, local, and industry regulations and standards. This includes maintaining relationships with government and commercial payers by accurately and promptly responding to credentialing requests. Additionally, this position will develop action steps for business expansion—including determining additional payers, states, and product lines.
Key Responsibilities include:
- Manage payer credentialing process, including commercial and government payers (Medicare, Medicaid), ensuring adherence to each payer’s requirements.
- Develop and maintain processes that provide timely notification and completion of critical payer contract events (e.g., recredentialing, renewals, termination and due dates contained within the agreements).
- Conduct thorough research to identify potential contract opportunities that align with the organization's mission, goals, and projects.
- Maintain current knowledge of applicable federal and state laws, pending legislation reported in the federal register, revised accreditations standards, licensure requirements, and updated OIG (Office of Inspector General) work plans.
- Monitor state and federal rules and regulations that may affect company wholesale/retail distribution of DME.
- Provide oversight and assist in monitoring and assessment of key quality indicators that are reported to the State, CMS, and DME accreditation bodies.
The Successful Candidate will bring:
- 7 years’ experience in industry leadership role. Durable Medical Equipment (DME) experience preferred.
- Experience with Medicare/Medicaid portals and accreditation agencies preferred.
- Strong payer relationship management experience, ideally with existing insurer contacts.
- Expertise in contract negotiation, compliance, and regulatory frameworks.
- Resilient in a fast-changing, growth-oriented company.
- College degree required. Master’s degree in health administration, business, or law preferred.
