Senior Director Payor Relations

Job Type Full-time Description

Soleo Health is seeking a Sr. Director Payor Relations to support our Specialty Pharmacy and Home Infusion operations. Join us in Simplifying Complex Care! 

 

Soleo Health Perks:    

• Competitive Wages  
• 401(k) with a Match 
• Referral Bonus    
• Paid Time Off 
• Great Company Culture  
• Paid Parental Leave Options 
• Affordable Medical, Dental, & Vision Insurance Plans 
• Company Paid Disability & Basic Life Insurance 
• HSA & FSA (including dependent care) Options 
• Education Assistance Program 

The Position: 

The Senior Director of Payor Relations is an executive role focused on driving the strategic direction, development, and overall management of Payor Relations across the company. This executive will play a critical role in shaping the company’s approach to healthcare contracting and network management at a national level. The Senior Director will lead efforts to optimize the reimbursement Soleo receives for its services through various payor relations strategies, ensuring they align with the company's long-term strategic and financial objectives and maximize the company’s earnings potential. Responsibilities Include: 

• Formulate and oversee the implementation of comprehensive regional and national Payor contracting and network management strategies. Drive the achievement of contracted sales goals and enhance market share and profitability.
• Lead the identification, development, negotiation, and management of Payor Relations agreements to ensure competitive and sustainable growth.
• Initiate and guide the launch of innovative Payor relations programs and contracts, collaborating with senior internal stakeholders including operations, finance, and Regional Vice Presidents.
• Oversee detailed financial analyses of Payor contracts to assess the earnings impact of new contracts, as well as renewals and material network changes. 
• Manage budget projections for pricing and assess financial performance of payor contracts.
• Ensure Payors are reimbursing Soleo at the contracted rates and that reimbursement is timely.
• Enhance Soleo’s contracting strategy to maximize value (where applicable) using national contracts with chain codes vs. individually contracted pharmacies.
• Serve as the primary executive contact for major external partners, including hospitals, Payor organizations, and manufacturers. Build and maintain strategic relationships to bolster business objectives.
• Oversee the design and implementation of advanced sales training programs that focus on Payor relations, contract comprehension, opportunities, and associated risks.
• Monitor and analyze market trends and contractual activities to identify and seize opportunities for new or expanded Payor agreements.
• Lead the development of performance-based contracting models that reflect the latest in healthcare industry advancements and match organizational goals (i.e., Soleo’s participation in limited payor networks).
• Maintain and update the company's strategy in response to healthcare legislation changes. Act as a subject matter expert to guide Payor Relations policies and practices.
• Perform other duties as assigned.
• Partner with Revenue Cycle Management team to defend Soleo’s interests in payor audits.

Requirements

• Bachelor’s degree in a related field such as business administration, economics or finance with a minimum of 10 years in Payor Relations and Contracting including significant leadership experience in complex healthcare environments.
• Advanced degrees such as an MBA or Juris Doctorate preferred.
• Strong communication, negotiation, and leadership skills.
• Proven track record of leading high-performing teams and effectively managing senior-level projects and initiatives.
• Exceptional capability in analyzing complex data, identifying strategic insights, and employing them to improve business performance and operational efficiencies.
• Expertise in developing and delivering strategies and business plans to a variety of stakeholders, including executive leadership, board members and external partners.
• Operates effectively and successfully in fast-paced high growth environment. Capable of managing multiple, high-stakes projects in parallel with one another.
• Willingness and ability to travel extensively, often exceeding 50% of the time, to meet business needs.

 

About Us: Soleo Health is an innovative national provider of complex specialty pharmacy and infusion services, administered in the home or at alternate sites of care. Our goal is to attract and retain the best and brightest as our employees ar