Director, Payor Relations

Cook Children's Health Care System

$100K — $130K *
Healthcare
8 - 10 years of experience
Job Overview by Ladders

Qualifications

  • Bachelor's degree preferred.
  • 10+ years of experience in a managed care setting required.
  • Extensive contract negotiation and payor relations experience required.
  • Superior knowledge of medical terminology is essential.
  • Ability to foster effective relationships with outside payors is crucial.
  • Detail-oriented with strong verbal and written communication skills.
  • High-level problem solving and presentation skills are necessary.
  • Capable of working independently while effectively supervising staff.

Responsibilities

  • Develop and maintain relationships with managed care organizations.
  • Secure, manage, and renegotiate health care service contracts.
  • Oversee contract implementation and validation.
  • Manage payor intelligence and resolve contract-related issues.
  • Coordinate follow-up on claims issues related to contracts.

Benefits

  • Comprehensive health insurance plans offered.
  • Opportunities for professional development and growth.
  • Supportive team environment fostering collaboration.
  • Flexible working hours with a first shift schedule.
  • Work-life balance initiatives promoted by the organization.
Full Job Description
Location:

Calmont Operations Building

Department:

Payor Relations

Shift:
First Shift (United States of America)

Standard Weekly Hours:

40

Summary:

The Director of Payor Relations is responsible for developing and maintaining meaningful and effective relationships with managed care organizations and internal staff with the goal of securing, managing, and renegotiating viable, revenue generating health care service contracts on behalf of CCHCS entities and providers with both commercial and government funded managed care organizations. The Director will manage payor intelligence, contract implementation and validation as well as oversee issues and follow up on contract related claims issues.

Qualifications:
  • Bachelor's degree preferred.
  • At least ten (10) years of operational experience in a manage care setting required.
  • Extensive experience in contract negotiation and payor relations required.
  • Superior knowledge of medical terminology.
  • Must be able to foster and maintain healthy relationships with outside payors. Must have a clear understanding of the intricacies of commercial, state and federal government funded insurances.
  • Must be detail oriented with a high level of verbal and written communication skills.
  • Must have high level of problem solving and presentation skills.
  • Must be able to work independently, effectively supervise staff and actively participate as an integrated team member.


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