Director - Payor Relations

The Payor Relations Director leads and maintains relationships with internal and external sources involved in the contracting process and helps develop negotiation strategies. Work with Chief Growth Officer to research paths to grow exams, contract negotiations, projects, and conversion within Keplr locations. Including researching new opportunities for growth in medical payors and serving as a liaison with Credentialing and Revenue Cycle Management. The role interacts with internal and external parties regarding communication/questions about rates and terms, rate structure and development and reconciliation of contract provisions and disputes.  Necessary financial acumen to understanding the impacts of potentials project and strategies.

Responsibilities

• Build data models to forecast and monitor payor rates by code
• Assist in key Projects - i.e. Analysis Lab vs NonLab Models, Obtain practice data, Fee schedule consolidation, etc.
• Building and maintaining relationships with payors, including resolving disputes, and identifying opportunities for network expansion   
• Managing contract renewals and amendments   
• Communicate and educating departments on new payors and plans, and providing guidance on contract-related issues 
• Collaborating with internal and external stakeholders to ensure accurate billing and payment processes   
• Evaluate new payors/networks and their fees for participation
• Thoroughly analyze and review rates and utilization to drive mutually beneficial outcomes for patients and providers
• Analyze fee schedules by specialty and code relative to historical company utilization
• Track contracts and anniversary dates to ensure annual rates are implemented correctly and on time
• Maintain the tickets submitted to Payor Relations through Fresh Service
• Assist in developing and maintaining appropriate policies, procedures, and controls for Optometry contracts and payor contracting activity
• Other duties as assigned

Qualifications

• 5+ years of experience with a Multi-Practice Group, or Managed Vision Care Payor
• Optometry/Ophthalmology experience with emphasis in Payor Relations or Contracts
• Knowledge of CPT/HCPC codes and terminology required
• Prior fee analysis and negotiations experience required
• Advanced excel skills are necessary
• Actuarial experience/qualifications highly desirable
• Strong organizational skills, accuracy, and attention to detail
• Leadership/Relationship skills to interact with internal and external constituents from entry level to CEO