Director of Payor Contracting

Description

Who We Are:

Platinum Dermatology Partners is a network of high-quality dermatology clinics that focus on collaborative and innovative ideas to drive growth. We offer general dermatology, cosmetic, medical, plastic surgery, and cancer screening treatments. We have over 130 clinics, 350 providers, and 2200 employees in clinics across Texas, Arizona, California, Nevada, and Florida. We are a rapidly growing company that allows our doctors to focus on providing exceptional care without worrying about the operational side of the business. Our core values focus on collaboration, ownership, respect, excellence, authenticity, and integrity. Our purpose is to empower the practice of exceptional dermatology.

Company Conformance Statements:

In the performance of their respective tasks and duties, all employees are expected to conform to the following:

• Perform quality work within deadlines with or without direct supervision.
• Interact professionally with other employees, customers, and suppliers.
• Work effectively as a team contributor on all assignments.
• Work independently while understanding the necessity for communicating and coordinating work efforts with other employees and organizations.

Position Overview:
The Director of Payor Contracting is responsible for developing and managing relationships with payors, negotiating favorable contract terms, and ensuring the financial performance of contracted services. This leader will work to secure optimal reimbursement rates while maintaining compliance with regulations and building strong partnerships with payors. The Director will play a crucial role in supporting Platinum Dermatology Partners' growth and financial results. This role will report to the Vice President of Revenue Cycle Management.

Key Responsibilities:

• Contract Negotiation & Management:
  Lead the negotiation, implementation, and management of new and timely renewals of existing payor contracts, ensuring favorable terms that align with Platinum Dermatology's financial and operational goals. 
• Payor Relationship Management:
  Build and maintain strong, collaborative relationships with key payors to enhance the company's network position and secure optimal contract terms.
• Reimbursement Optimization:
  Analyze existing payor contracts to identify opportunities for improved reimbursement rates, terms, and overall performance. Monitor trends and adjust strategies as necessary.
• Market Analysis & Strategy:
  Conduct comprehensive analyses of market trends, reimbursement models, and emerging payor strategies to identify opportunities for new payor contracts and partnerships.
• Compliance & Regulatory Oversight:
  Ensure all payor contracts comply with relevant federal, state, and local laws and regulations. Stay informed of changes in healthcare regulations affecting payor agreements.
• Collaboration with Revenue Cycle & Operations Teams:
  Work closely with the revenue cycle management, operations, and finance teams to align payor contracting strategies with broader organizational goals. Ensure contracts support effective revenue cycle processes and operational efficiency address operational issues with payor contract compliance and develop and modify language to be incorporated in future contracts or amendments
• Performance Monitoring:
  Monitor payor contract performance, including reimbursement trends, payment timeliness, and contract adherence. Provide regular updates and reports to leadership on contract performance and areas for improvement. Develops and maintains payor contract summaries with key details, including line of business, effective date, end date, termination notice period, and percentage rates with escalators. 
• Dispute Resolution:
  Serve as the primary point of contact for payor-related disputes, working to resolve issues quickly and effectively to minimize financial disruption.

Qualifications

Education:

• Bachelor’s degree in healthcare administration, business, finance, or related field.

Qualifications/Experience:

• Minimum of 7 years of experience in healthcare payor contracting, with a strong understanding of contract negotiation, reimbursement methodologies, and healthcare regulations.
• Experience in dermatology or a related specialty is preferred.
• Demonstrated success in managing payor relationships and achieving favorable contract outcomes.
• Strong analytical skills, with the ability to interpret complex data and translate it into actionable strategies.
• Excellent communication and negotiation skills.
• Knowledge of healthcare laws and regulations affecting payor contracting, including Medicare and Medicaid guidelines.

Our competitive benefits package includes the following:

• Medical, Dental, and Vision insurance
• Short-term/Long-term disability
• Life and other voluntary plans
• 401(k) plan
• Employee Referral Program
• Paid Time-Off
• Company-Paid Holidays

Equipment Operated: Standard office equipment including computers, fax machines, copiers, printers, telephones, etc.

Physical Requirements: Must possess manual dexterity to operate office machines including computer and calculator; stooping and bending to handle files and supplies; and mobility to complete errands or deliveries. Includes handling of sharps and chemicals.

Equal Employment Opportunity:

Platinum Dermatology Partners is committed to a policy of equal employment opportunities for applicants and Employees. Employment decisions will comply with all applicable laws prohibiting discrimination in employment, including Title VII of the Civil Rights Act of 1964, The Age Discrimination in Employment Act of 1967, the Americans with Disabilities Act of 1990, the Immigration and Nationality Act, the California Fair Employment and Housing Act, and all other applicable state and federal laws.

Platinum Dermatology Partners does not permit discrimination of any type against an employee because of any of the following legally protected characteristics: gender, race, color, religion, country of origin, mental disability, physical disability, marital status, gender identity, gender expression, ancestry, genetic information, medical condition, age, sexual orientation, or pregnancy.

Please note, that any offer of employment is contingent on the successful completion of pre-employment background checks.

No phone calls or agencies, please.