The Senior Director of Payer Relations is responsible for developing relationships and reference materials to assist membership in navigating payer relationships and concerns. This person will serve as a resource in guiding members through relationship development with Medicare Advantage, Managed Care, and Medicaid payers. This position will work with key leadership and the payers and/or CMS for overarching payment and audit issues. They will stay abreast of rules and regulations from CMS to ensure the Medicare Advantage payers are following these appropriately. This person will work in coordination with other members of leadership to identify areas of opportunity for the association in meeting the ever-changing needs in the health care spectrum. They will utilize payer relationships to engage new membership and retain current membership.
Essential Functions and Job Responsibilities
- Strategic Program Development/Management:
- Knowledge of and ability to develop and communicate policies, standards, and procedures to improve organizational compliance.
- Identifies and implements strategies to achieve all Payer Relations Goals.
- Works within the organization to support all association initiatives.
- Contributes to the achievement of corporate objectives/goals by utilizing the payer relationship spectrum to grow membership.
- Functions as a change agent in response to Medicare Advantage Audits to support membership in developing strategies and resource materials.
- Promotes customer service philosophy and impact on customer relations.
- Prioritizes own work to meet deadlines and project time frames.
- Works in close collaboration with VP of Regulatory Affairs to help facilitate change based on current audit environment.
- Perform educational sessions for AAhomecare regarding Medicare Advantage Payers that result from industry environmental scans.
- Collaborates with key membership in development of outcomes tracking for DME providers.
- Complies with federal, state, and local legal requirements by being aware of existing and new legislations and regulatory changes as related to clinical policies (LCDs).
- Leadership Skills
- Decision Making
- Strong analytical and problem solving skills with attention to detail
- Excellent verbal and written communication
- Excellent customer service skills
- Proficient computer skills and knowledge of Microsoft Office
- Ability to prioritize and manage multiple projects
- Bachelor’s degree
- Five years work related in health care administration.
- Must possess extensive knowledge of Microsoft Office including Word, Excel, and PowerPoint.