Director of Payor Contracting

JOB TITLE: Director of Payor Contracting 
FLSA STATUS (Exempt/Non-Exempt): Exempt 
SUPERVISION RECEIVED: Reports to Chief Executive Officer 
SUPERVISION EXERCISED: Payor Contracting and Reimbursement Staff 

GENERAL STATEMENT OF DUTIES 

Responsible for leading and managing Premier and Philadelphia Hand to Shoulder payor contracting strategy and contract portfolio across commercial, Medicare Advantage, Managed Medicaid, workers' compensation, auto, and other applicable payor arrangements. Leads contract negotiations, develops reimbursement strategies, manages the full contract lifecycle, evaluates financial and operational performance of payor agreements, and ensures executed contractual rates and terms are appropriately implemented and monitored. Partners closely with Revenue Cycle Management, Finance, Credentialing, Quality, Operations, physicians, and executive leadership to optimize reimbursement, identify and mitigate contractual risk, support value-based care arrangements, and advance the organization's strategic and financial objectives. 

ESSENTIAL FUNCTIONS 

• Leads payor contracting strategy and negotiations across commercial, Medicare Advantage, Managed Medicaid, workers' compensation, auto, direct-to-employer, and other applicable agreements.  

• Serves as the lead negotiator for major payor agreements and develops negotiation objectives and strategies for leadership approval.  

• Develops financial and reimbursement analyses to support contract negotiations, including market benchmarking, cost-to-serve analysis, and code-level modeling of surgical, non-surgical, imaging, ancillary, and advanced practice provider reimbursement.  

• Negotiates and structures multi-year reimbursement arrangements, percent-of-CMS fee schedules, surgical carve-outs, escalator provisions, case rates, bundled payments, percent-of-charge arrangements, and other reimbursement methodologies.  

• Evaluates proposed contract terms and reimbursement changes to determine financial, operational, and strategic impact to Premier and Philadelphia Hand to Shoulder. 

• Develops and maintains senior-level relationships with payor network, contracting, and medical leadership.  

• Leads payor escalations, contractual disputes, and termination scenarios and coordinates single-case agreements for non-contracted services as appropriate.  

• Presents contracting strategies, financial analyses, recommendations, and negotiation outcomes to executive leadership and other applicable governing bodies.  

• Owns and maintains the organization's payor contract system of record, including executed agreements, amendments, exhibits, fee schedules, and related documentation.  

• Establishes and maintains accurate contract renewal, expiration, and notice calendars to ensure contractual deadlines are identified and managed proactively.  

• Reviews and manages key contractual provisions, including payment-policy-change provisions, notice and termination requirements, authorization requirements, reimbursement methodologies, and other material contract terms.  

• Ensures executed agreements and amendments are appropriately documented, communicated, and operationalized across applicable departments.  

• Leads or participates in joint operating committee meetings with major payors and maintains appropriate issue logs, action items, and resolution tracking.  

• Partners with Revenue Cycle Management, Credentialing, Finance, and other departments through established contracting and payor governance processes.  

• Evaluates the financial impact of payor policy and reimbursement changes, including multiple procedure payment reductions, site-of-service changes, coverage policies, and other reimbursement modificati