JOB SUMMARY:
This role owns the
payer ecosystem strategy and contract lifecycle, ensuring that reimbursement agreements are financially optimized, operationally executable, and fully aligned with regulatory requirements and organizational growth objectives.
The Senior Director, Healthcare Payer oversees the growth full lifecycle of payer, provider, and network contracting for a DME healthcare organization. This leader ensures all contracts support financial sustainability, operational efficiency, compliance, and strategic growth. The role requires deep knowledge of Medicare, Medicaid, commercial insurance, and DME-specific reimbursement policies. The Senior Director, Healthcare Payer drives contract strategy leads negotiations, analysis of value of contracts, maintains payer relationships, and ensures the company remains competitive, compliant, and positioned for long-term success.
This role often partners closely with funding operations, revenue cycle, legal, compliance, and Market senior leadership team
KEY RESPONSIBILITIES:
Contract Strategy & Execution- Develop and implement a comprehensive contracting strategy for payer and provider agreements.
- Lead negotiation, renewal, and execution of contracts across Medicare, Medicaid, Medicaid MCOs, Medicare Advantage, commercial payers, ACOs, IDNs, and other DME funding channels.
- Conduct financial and strategic analysis of proposed contract terms to ensure strong reimbursement and sustainable margins.
- Develop and implement a comprehensive contracting strategy for payer and provider agreements.
- Lead negotiation, renewal, and execution of contracts across Medicare, Medicaid, Medicaid MCOs, Medicare Advantage, commercial payers, ACOs, IDNs, and other DME funding channels.
- Conduct financial and strategic analysis of proposed contract terms to ensure strong reimbursement and sustainable margins.
Relationship Management- Establish and maintain strong working relationships with payer partners, network managers, and governmental bodies.
- Hold payers accountable for contractual obligations, rate adherence, and performance expectations.
- Serve as the organization's representative in payer discussions, escalations, and contracting forums
DME & Healthcare Policy Expertise- Monitor and interpret federal and state healthcare regulations affecting DME (CMS rules, reimbursement changes, enrollment requirements, fraud/waste/abuse regulations, etc.).
- Advise senior leadership on policy shifts affecting reimbursement, authorization, funding, and operational requirements.
- Ensure compliance with DME supplier standards, credentialing, enrollment processes, and payer-specific requirements.
Compliance & Risk Management- Ensure all contracts comply with federal and state laws including Medicare supplier standards, Anti-Kickback Statute, False Claims Act, HIPAA, Medicaid guidelines, and other regulatory frameworks.
- Partner with Legal, Compliance, and Revenue Cycle teams to mitigate risk and ensure aligned processes.
Revenue Enablement - Identify new payer participation opportunities and alternative funding pathways aligned with organization growth goals.
Cross-Functional Leadership- Collaborate with Revenue Cycle, Billing & Collections, Reimbursement, Clinical, and Finance teams to ensure contract terms are operationally achievable.
- Support reimbursement programs, appeals strategy, and payer performance improvement initiatives.
- Provide internal education and support on contract terms, payer policies, and DME funding pathways.
Data & Performance Management- Oversee contracting KPIs, reimbursement outcomes, payer performance trends, and operational impacts of contract changes.
- Partner with analytics teams to monitor contract performance and identify areas for optimization.
MINIMUM QUALIFICATIONS:EDUCATION / EXPERIENCE REQUIREMENTS:
- 10+ years in strategic healthcare contracting, payer relations, or reimbursement (DME strongly preferred).
- Deep understanding of Medicare/Medicaid reimbursement structures, managed care, fee-for-service, and value-based arrangements.
- Strong knowledge of federal/state regulatory requirements for DME suppliers.
OTHER SKILLS/KNOWLEDGE REQUIREMENTS:
- Demonstrated negotiation success with national and regional payers.
- Excellent communication, analytical, and cross functional leadership skills.
- Ability to interpret complex policy/regulatory documents and translate into business strategy.
WORK ENVIRONMENT REQUIREMENT: - Hybrid, 2-3 days in office
- 15% travel requirement
Apply today! We believe in empowering individuals - including our own employees - to reach their full potential. So, if you want to change lives while growing your own career, we'd love to hear from you.
