Director of Payor Relations

Director of Payor Relations

Reports to: Chief Financial Officer
Location: Lakewood, CO (Hybrid)
Status: Full-time, Exempt

About Bloom Healthcare

Bloom Healthcare is a Denver-based, patient-centered healthcare organization dedicated to delivering high-quality, accessible care across the Colorado Front Range. Grounded in a culture of innovation, integrity, and compassionate service, Bloom Healthcare partners with payers, providers, and communities to create a healthier Colorado. As we continue to grow our network and expand our managed care portfolio, we are seeking an experienced and strategic leader to join our team as Director of Payor Relations.

Position Summary

The Director of Payor Relations is a high-impact leadership role designed for a healthcare professional who is ready to own a broader portfolio and make a real mark at a growing organization. This position is well-suited for someone who has built genuine expertise in one or more payor-facing disciplines — managed care contracting, revenue cycle management, or provider credentialing — and is now ready to lead with authority across all three.

At Bloom Healthcare, you won’t be one voice among many in a large system. You’ll have direct access to senior leadership, meaningful autonomy, and the room to build something. If you have been a strong contributor or rising leader in a larger organization and are ready for a role where your decisions drive outcomes every day, this is that opportunity.

This role is responsible for strategy and day-to-day execution across all payor-facing functions, with a mandate to strengthen relationships, optimize reimbursement, and build durable operational infrastructure as we grow.

Key Responsibilities

Managed Care Contracting

• Lead the negotiation, execution, and ongoing management of contracts with commercial health plans, Medicare Advantage, Medicaid managed care organizations, and other third-party payers.
• Develop and implement contracting strategies that optimize reimbursement rates, fee schedules, and value-based payment arrangements.
• Analyze contract terms, performance metrics, and financial outcomes to identify opportunities for renegotiation and improvement.
• Maintain a comprehensive contract database and ensure timely renewals and compliance with all contractual obligations.
• Monitor industry trends, regulatory changes, and competitive landscapes to inform contracting strategy.
• Collaborate with legal counsel on contract language, compliance requirements, and risk mitigation.

Revenue Cycle Management

• Oversee the full revenue cycle continuum, including charge capture, claims submission, denial management, payment posting, and accounts receivable follow-up.
• Establish and monitor key performance indicators (KPIs) for revenue cycle operations, including clean claim rates, denial rates, days in accounts receivable, and collection ratios.
• Identify and implement process improvements to reduce denials, accelerate cash flow, and maximize net revenue.
• Partner with clinical, coding, and billing teams to ensure documentation integrity and accurate, compliant claim submission.
• Manage relationships with revenue cycle vendors and clearinghouses, ensuring performance standards are met.
• Lead preparation and analysis of revenue cycle reporting for senior leadership and the Board of Directors.
• Ensure compliance with payer billing requirements, federal and state regulations, and organizational policies.

Provider Credentialing

• Direct the provider credentialing and re-credentialing process for all clinical staff across payer networks, ensuring timely enrollment and ongoing compliance.
• Oversee management of the Provider Enrollment and Credentialing team, establishing workflows, timelines, and quality standards.
• Maintain provider credentialing files in compliance with NCQA, URAC, Joint Commission, and payer-specific standards.
• Serve as the primary organizational contact for payer credentialing departments and resolve enrollment issues and disputes.
• Implement and maintain a credentialing software platform to support efficient, auditable processes.
• Coordinate with Human Resources and Clinical Operations on onboarding timelines to minimize provider start-date delays.

Payor Relations & Strategy

• Cultivate and maintain strategic relationships with key health plan representatives, medical directors, and network management teams.
• Serve as the primary organizational liaison for escalated payor issues, disputes, and joint operating committee meetings.
• Represent Bloom Healthcare in payor negotiations, network adequacy discussions, and value-based care program development.
• Advocate for Bloom Healthcare’s providers and patients in payor policy discussions, utilization management reviews, and appeals processes.
• Monitor and respond to changes in payor policies, reimbursement methodologies, and network requirements.

Leadership & Team Management

• Recruit, develop, and retain a high-performing team of revenue cycle specialists, credentialing coordinators, and contracting analysts.
• Provide coaching, mentorship, and professional development opportunities to direct reports.
• Establish department goals, performance metrics, and accountability structures aligned with organizational objectives.
• Foster a collaborative, solutions-oriented team culture committed to operational excellence and continuous improvement.
• Prepare and manage the departmental budget, ensuring responsible resource allocation.

Qualifications

Required

• Bachelor’s degree in Healthcare Administration, Business Administration, Finance, or a related field; advanced degree (MHA, MBA, or equivalent) a plus but not required.
• 4–7 years of experience in healthcare with meaningful exposure to at least one of the following: managed care contracting, revenue cycle management, or provider credentialing/enrollment.
• Working knowledge of all three functional areas — managed care, revenue cycle, and credentialing — with genuine depth in at least one; demonstrated willingness and ability to grow across the others.
• Experience working directly with health plans, including commercial insurers, Medicare Advantage, and/or Medicaid managed care organizations.
• Familiarity with revenue cycle fundamentals: claims submission, denial management, accounts receivable, and payer billing requirements.
• Understanding of provider enrollment and credentialing processes and relevant compliance standards (NCQA, URAC, CMS).
• Strong analytical and problem-solving skills; comfort working with data to identify trends and drive decisions.
• Clear, confident communicator with the interpersonal skills to build relationships internally and externally.
• A self-starter mindset — someone who sees what needs to be done and does it, without waiting to be asked.

Preferred

• Prior experience in a director, manager, or team lead capacity, even informally or in a project leadership context.
• Certification in Revenue Cycle (CRCR, CRCS), Healthcare Management (CMPE), or a related credential — or active pursuit of one.
• Experience with value-based care models including shared savings, capitation, or pay-for-performance arrangements.
• Familiarity with Epic or other EHR and practice management platforms.
• Experience in a smaller or growing organization where you wore multiple hats and built processes from the ground up.
• Colorado healthcare market familiarity, including state Medicaid managed care programs and Front Range payer landscape.

A Note on Fit
We are not looking for someone who has already done every part of this job. We are looking for someone who is hungry to. The ideal candidate brings a strong foundation, a track record of learning fast, and the confidence to lead in areas where they are still growing. If you have deep expertise in one or two of these disciplines and solid working knowledge of the rest, we want to hear from you.

Compensation & Benefits

Bloom Healthcare offers a competitive compensation package commensurate with experience, including:

• Base salary range: $120,000 – $150,000 annually, depending on qualifications and experience.
• Annual performance-based incentive bonus.
• Comprehensive medical, dental, and vision insurance.
• Employer-sponsored 401(k).
• Generous paid time off, paid holidays, and CME/professional development allowance.
• Hybrid work flexibility (Lakewood-based role; some remote work available).

Equal Opportunity Employer
Bloom Healthcare is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees, regardless of race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.

Bloom Healthcare only contacts through official channels using the @bloomhealthcare.com domain. We are aware of a fraudulent Gmail account impersonating our recruiting team and have reported it to Google.