Director of Payer Strategy & Contracting

About the role
The Director of Payer Strategy & Contracting will lead the strategic development and execution & negotiation of telehealth service contracts with payers. This role is responsible for creating and implementing innovative contracting strategies to enhance the Found’s market position and financial performance. The Director will oversee provider enrollment and credentialing functions, manage credentialing vendor(s) and internal team, and work in concert to support the Revenue Cycle Management (RCM) functions. The Director will collaborate with internal stakeholders, including finance, clinical operations, and legal & compliance teams, to ensure the alignment of payer contracts with organizational goals.

What you'll do (Job Responsibilities)

Strategic Planning:

• Review, refine, and implement a comprehensive strategy for Found’s initial and ongoing payer contracting approach
• Identify market opportunities and emerging trends in telehealth to inform strategic planning
• Collaborate with executive leadership to align the contracting strategy with overall organizational objectives and goals

Revenue Cycle Management (RCM) Support:

• Collaborate with the RCM team to ensure telehealth contracts support optimal revenue cycle performance.
• Provide guidance on billing and reimbursement issues related to telehealth services.
• Address and resolve payer-related issues impacting RCM functions.

Provider Enrollment and Credentialing:

• Lead and manage provider enrollment and credentialing functions to ensure timely and accurate provider onboarding.
• Develop and implement processes to streamline and improve provider credentialing.
• Ensure compliance with all credentialing and enrollment regulations and standards.
• Oversee credentialing vendors and ensure their performance meets organizational standards.

Market Analysis:

• Conduct market research and analysis to identify competitive trends and opportunities. 
• Assess the financial impact of contracts and propose strategies to maximize revenue and reimbursement
• Monitor and analyze changes in telehealth reimbursement policies and regulations

Contract Negotiation:

• Establish and maintain strong relationships with payer representatives to facilitate successful negotiations
• Lead the negotiation of contracts with applicable commercial payers as defined by the over arching payer strategy
• Ensure contracts are financially favorable and compliant with regulatory requirements

Stakeholder Collaboration:

• Work closely with internal teams, including finance, operations, legal, and clinical departments, to support fee for service initiatives.
• Provide guidance and support to operational teams to ensure the successful implementation of payer contracts
• Communicate effectively with senior leadership and other key stakeholders to report on contracting activities and outcomes

Performance Management:

• Establish metrics and KPIs to evaluate the performance of payer contracts
• Monitor contract performance and identify areas for improvement
• Prepare and present regular reports on telehealth contract performance to senior leadership

Education: Bachelor’s degree in Business Administration, Healthcare Administration, Finance, or a related field required. Master’s degree desirable.

Experience: Minimum of 7-10 years of experience in healthcare payer contracting, with a minimum 2-3 year focus on telehealth services.

• Proven track record of successful contract negotiation with commercial and government payers.
• Experience in strategic planning and market analysis.
• Experience managing provider enrollment and credentialing functions.
• Knowledge of Revenue Cycle Management processes and best practices.

Skills:

• Strong understanding of telehealth services and reimbursement models.
• Excellent negotiation and communication skills.
• Ability to analyze complex data and make strategic decisions.
• Strong leadership and project management skills.
• Knowledge of healthcare regulations and compliance.
• Proficiency in credentialing and enrollment software and systems.