Director of Payor Relations

About the role

The serves as the single point of accountability for all payor relationships, contracts, negotiations, and strategic initiatives within an assigned regional portfolio. This senior individual contributor role owns the complete lifecycle of payor contract management, from market research and relationship building to renegotiation and operational translation. The position operates with a high degree of autonomy while ensuring strict alignment with enterprise objectives and financial targets. The role is critical to interpreting complex reimbursement requirements and converting them into clear guidance for Revenue Cycle, Finance, Credentialing, and Operations teams. The Director will lead cross-functional initiatives to secure favorable terms and resolve intricate payor issues across a multi-state, multi-TIN network. This position directly supports the mission of relieving vein disease symptoms and improving patient quality of life within a rapidly growing practice. The role reports strategic insights and performance data to support enterprise strategy in a PE-backed, high-growth specialty environment.

Key facts

What you'll do

• Serve as the single point of accountability for all payor relationships, contracts, negotiations, and strategic initiatives across an assigned regional portfolio, ensuring outcomes across every payor, market, and clinic location within that region.
• Lead payor contract negotiations across all commercial, Medicare Advantage, and Medicaid managed care plans within the assigned region, securing favorable rates and terms aligned with organizational benchmarks.
• Maintain a current and comprehensive understanding of the regional payor landscape, including plan relationships, contract status, network participation, fee schedule benchmarks, and market-specific dynamics.
• Build and maintain senior-level relationships with health plan contracting and network management teams operating within the region to foster collaboration and trust.
• Ensure all regional payor contracts, fee schedules, amendments, and provider enrollment statuses are accurate, compliant, and up to date within the organization's contract management systems.
• Serve as the regional escalation point for complex payor issues, including claims disputes, authorization denials, credentialing holds, payment variances, and systemic billing problems.
• Own the full contract management and modeling function for the region, including timely updates to reimbursement methodologies, fee schedules, and contract term dates.
• Interpret payor contract terms, reimbursement methodologies, and state-specific requirements, translating them into standardized, scalable operational guidance for consistent execution across markets.
• Monitor payor performance, reimbursement trends, and policy changes across the region; proactively identify revenue leakage, underpayments, and systemic denial patterns before they impact revenue.
• Conduct regular market reviews across current payor relationships to identify and close network participation gaps, ensuring all applicable plans and product lines are active for each contracted payor.
• Develop and maintain financial models, benchmarking analyses, and rate impact assessments to support regional negotiations and executive reporting.
• Collaborate with Revenue Cycle, Finance, Credentialing, and Operations teams to ensure alignment on payor strategies and implementation across clinic locations.
• Drive data-informed decision-making by analyzing performance metrics, contract compliance, and market opportunities to optimize reimbursement and reduce administrative friction.
• Represent Metro Vein Centers in regional payor forums and industry discussions to advocate for favorable policies and network positioning.

Requirements

• Bachelor's degree in Healthcare Administration, Business, Public Health, or a related field; an advanced degree is preferred.
• Minimum of 7 years of progressively responsible experience in payor relations, managed care contracting, or a related role within a healthcare environment.
• Demonstrated success in managing complex payor contracts and negotiations across multiple payors and product lines.
• Strong understanding of Medicare Advantage, Medicaid managed care, and commercial insurance contracting models and reimbursement methodologies.
• Proven ability to interpret complex policy documents, regulatory requirements, and contract language, translating them into actionable operational steps.
• Experience with contract management systems, revenue cycle processes, and financial modeling in a healthcare setting is required.
• Excellent relationship-building and communication skills, with the ability to influence senior stakeholders and cross-functional teams remotely.
• Self-motivated with strong time management and organizational skills to manage multiple priorities in a fast-paced, high-growth environment.
• Deep commitment to compliance, accuracy, and ethical standards in all payor-related activities.
• Willingness to travel regionally for meetings, if required, and work within U.S. time zones to support clinic operations.

Nice to have

• Experience in a physician practice or ambulatory surgery setting with a focus on vascular and vein care services.
• Familiarity with electronic health records and healthcare revenue cycle technology platforms.
• Background in quality improvement, data analytics, or population health within a vascular specialty environment.
• Knowledge of state-specific insurance regulations and telehealth reimbursement policies relevant to vein services.

Practical notes

This is a remote, full-time position based in the United States. Travel may be required regionally for meetings as needed. Candidates must be able to work within U.S. time zones to support clinic operations and cross-functional collaboration.