Director of Contracting & Payor Relations in United States at Jobgether

The Director of Contracting & Payor Relations will establish and execute the organization's payor strategy, optimize contractual performance, and strengthen relationships with insurance carriers and network partners. Key responsibilities include:

• Develop and manage enterprise-wide payor strategies covering commercial dental PPO plans, leased and umbrella networks, medical plans for oral surgery, and government programs.
• Lead fee schedule negotiations and renegotiations with national and regional carriers, including specialty-specific reimbursement schedules.
• Evaluate direct contracting versus leased network participation and recommend out-of-network or contract termination decisions using revenue projections and patient retention modeling.
• Create and maintain payor performance scorecards tracking patient volume, net collection rates, write-offs, and reimbursement for key procedure codes.
• Model the financial impact of proposed contracts and provide rate assumptions for budgeting, forecasting, and board reporting.
• Coordinate provider credentialing and payor enrollment to ensure dentists are in network before seeing their first patients.
• Serve as the senior escalation point for systemic claim denials, underpayments, reimbursement downgrades, and payor recoupment demands.
• Assess payor agreements during acquisition due diligence and lead contract integration following acquisitions.
• Collaborate with Revenue Cycle, Operations, Clinical Leadership, and Compliance teams to improve payment accuracy, educate front-office teams, and communicate payor policy changes.
• Monitor state insurance regulations and assess their implications for contractual arrangements across operating markets.

Requirements:

The ideal candidate combines extensive payor contracting expertise with strong financial modeling capabilities, commercial negotiation skills, and experience managing complex healthcare networks. They should be comfortable advising senior executives and translating contractual decisions into measurable business outcomes. Required qualifications include:

• Bachelor's degree in Business, Finance, Healthcare Administration, or a related field; an MBA or MHA is an advantage.
• At least 8 years of experience in payor contracting, network management, or managed care, including a minimum of 3 years leading negotiations.
• Hands-on experience negotiating dental PPO fee schedules for a multi-location organization or working on the payor or network side.
• Working knowledge of CDT coding, dental benefit design, leased networks, and claims adjudication.
• Strong Excel-based financial modeling skills and a demonstrated track record of securing and documenting reimbursement rate improvements.
• Experience with provider credentialing and enrollment processes, including CAQH.
• Previous experience in a dental support organization (DSO), multi-site healthcare environment, or private equity-backed organization is preferred.
• Experience with acquisition integration, medical billing for oral surgery, or Medicaid dental programs is a plus.
• Strong analytical and communication skills, with a data-driven approach and the confidence to present recommendations to CFOs, executive leadership, and board members.

Benefits:

• Competitive base salary with an annual performance-based bonus opportunity.
• Medical, dental, and vision insurance.
• 401(k) retirement plan with employer matching.
• Disability insurance and life insurance.
• Employee assistance program.
• Employee discounts.
• Flexible spending account and health savings account options.
• Paid time off.
• Direct collaboration with the CFO and executive leadership team.
• Opportunity to build and shape a strategic business function with a measurable impact on financial performance.
• Remote work arrangement.