Director, Payor Relations and Regulatory Affairs
Accordance Search Group, Livermore, CA, United States
Our client is in search of a Director, Payor Relations and Regulatory Affairs. In this role you will be accountable for developing strategies and driving ongoing activities that maintain and expand payor coverage while ensuring the business remains compliant with standards required by The Joint Commission, state agencies, and CMS (Medicare/Medicaid).
About the Role
These activities include leading the development, implementation, and monitoring of processes related to commercial payor contracting, state licensing, and CMS enrollments. These processes span across all lines of business. Responsibilities
Directly hires, develops, and drives engagement for team members across Payor Relations and Regulatory departments Oversees essential activities and process improvement related to commercial payor contracting across all lines of business; specific contracting activities include, but are not limited to: Contract redlining Contract monitoring Contract management, including initial & ongoing credentialing Oversees essential activities and process improvement related to regulatory affairs for ACH; specific contracting activities include, but are not limited to: Medicare and Medicaid enrollments The Joint Commission Accreditation Maintains governance processes to ensure alignment to contracting and regulatory business expectations with cross-functional stakeholders, including: finance, commercial operations, revenue cycle management, legal, and the office of ethics & compliance Develops, maintains, and presents to leadership the KPIs/metrics related to areas of responsibility Contributes to business strategies related to commercial contracting, payor management, and regulatory compliance; examples include: patient access, pricing, payor management, Medicaid advocacy, state licensing applications, and accreditations. Qualifications
Bachelor’s Degree in a business discipline 10+ years relevant experience in payor contracting at a healthcare provider, payor, or network 5+ years directly interacting with regulatory agencies Demonstrated ability to develop, improve, and monitor commercial contracting processes Ability to work independently and managing competing priorities routinely. Required Skills
Master’s Degree in related field 5+ years experience in payor contracting within the DME/IDTF provider space 5+ years experience working directly with CMS (Medicare/Medicaid), The Joint Commission, and state licensing agencies
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These activities include leading the development, implementation, and monitoring of processes related to commercial payor contracting, state licensing, and CMS enrollments. These processes span across all lines of business. Responsibilities
Directly hires, develops, and drives engagement for team members across Payor Relations and Regulatory departments Oversees essential activities and process improvement related to commercial payor contracting across all lines of business; specific contracting activities include, but are not limited to: Contract redlining Contract monitoring Contract management, including initial & ongoing credentialing Oversees essential activities and process improvement related to regulatory affairs for ACH; specific contracting activities include, but are not limited to: Medicare and Medicaid enrollments The Joint Commission Accreditation Maintains governance processes to ensure alignment to contracting and regulatory business expectations with cross-functional stakeholders, including: finance, commercial operations, revenue cycle management, legal, and the office of ethics & compliance Develops, maintains, and presents to leadership the KPIs/metrics related to areas of responsibility Contributes to business strategies related to commercial contracting, payor management, and regulatory compliance; examples include: patient access, pricing, payor management, Medicaid advocacy, state licensing applications, and accreditations. Qualifications
Bachelor’s Degree in a business discipline 10+ years relevant experience in payor contracting at a healthcare provider, payor, or network 5+ years directly interacting with regulatory agencies Demonstrated ability to develop, improve, and monitor commercial contracting processes Ability to work independently and managing competing priorities routinely. Required Skills
Master’s Degree in related field 5+ years experience in payor contracting within the DME/IDTF provider space 5+ years experience working directly with CMS (Medicare/Medicaid), The Joint Commission, and state licensing agencies
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