[Hiring] Director, Payer Relations @Stellus Rx

Role Description

We're opening eyes, hearts and minds to the impact that a pharmacy team can have in changing lives. As part of Catalyst Health Group, Stellus Rx improves ease and outcomes in every moment that matters, along every health journey.

Join our group of talented, committed team members - pharmacists, pharmacy care coordinators, technologists, product strategists and more - to create and expand the delivery of personalized health support that people didn't even know could be possible.

The Director, Payer Relations for Stellus Rx will help our communities thrive as a key member of the Growth Team. You will work closely with Stellus Rx leaders and across the organization, as we work collaboratively to unlock the health of millions of Americans by turning "use as prescribed" into a guarantee, not a direction. We are a culture that is unabashedly driven by purpose. We are making a difference to our patients and team members while growing at an accelerated rate. If you love serving others and would like to make a material difference in an industry-transforming organization, then we invite you to apply to this role.

Accountabilities

• The Head of Payer Relations plays a pivotal role in fostering and managing relationships with payors to ensure optimal reimbursement rates, streamline billing processes, and enhance the financial health of the organization.
• This position requires strong negotiation skills, an in-depth understanding of healthcare reimbursement policies, and the ability to collaborate effectively with internal stakeholders and external payors.

Role and Responsibilities:

• Develop comprehensive strategies to optimize relationships with payors, including negotiating contracts, rates, and terms.
• Monitor industry trends, regulatory changes, and competitor activities to inform payor negotiation strategies.
• Collaborate with senior leadership to align payor strategies with organizational goals and objectives.
• Lead negotiations with payors to secure favorable contract terms, reimbursement rates, and payment methodologies.
• Evaluate proposed contracts and amendments to ensure alignment with organizational priorities and financial targets.
• Manage contract compliance, including monitoring performance metrics, resolving disputes, and implementing corrective actions when necessary.
• Oversee the credentialing and enrollment process for healthcare providers, ensuring timely and accurate submissions to payors.
• Maintain up-to-date knowledge of credentialing requirements, regulations, and accreditation standards.
• Coordinate with internal departments (e.g., provider relations, revenue cycle) to streamline credentialing workflows and minimize delays.
• Collaborate with revenue cycle management teams to identify opportunities for improving billing processes, claims submission, and reimbursement efficiency.
• Analyze revenue cycle data and performance metrics to identify trends, root causes of denials, and opportunities for revenue enhancement.
• Implement best practices and process improvements to optimize revenue cycle performance and reduce revenue leakage.
• Cultivate and maintain strong relationships with key stakeholders at payor organizations, including executives, contracting representatives, and network managers.
• Serve as the primary point of contact for payors regarding contract negotiations, issue resolution, and strategic initiatives.
• Advocate for the organization's interests while fostering collaborative partnerships with payors to achieve mutual goals.

Qualifications

• Bachelor's degree in Healthcare Administration, Business, Finance, or related field (Master's degree preferred).
• Extensive experience (5+ years) in healthcare payor relations, contract negotiation, and revenue cycle management.
• In-depth knowledge of healthcare reimbursement methodologies, including fee-for-service, value-based reimbursement, capitation, and bundled payments.
• Strong analytical skills with the ability to interpret financial data, assess contract performance, and develop actionable insights.
• Excellent communication, negotiation, and interpersonal skills, with the ability to influence stakeholders at all levels.
• Proven track record of successfully negotiating contracts, resolving complex issues, and achieving measurable results.
• Familiarity with healthcare regulations, compliance requirements, and industry standards related to payor contracting and reimbursement.

Location

Plano, Texas (Remote)

Department

1750 - Business Development

Employment Type

Full Time