Director of Contracts and Payor Relations

Director of Contracts and Payor Relations

Please make sure you read the following details carefully before making any applications.

FULLY ON-SITE IN MELVILLE 5-days/week

Reports To: Chief Operating Officer - BH

Supervises: NA

Salary: $110,000 - $140,000

The Director of Contracting and Network Development is responsible for the growth, negotiation, administration, and ongoing maintenance of all payer agreements across Always Compassionate Health's enterprise-wide service lines. Reporting to executive leadership, this hands-on role drives business development by securing new payer contracts—specifically expanding network participation into Home Infusion, Specialty Pharmacy, Hospice, and County/DSS programs, while actively clearing administrative contract backlogs, managing re-credentialing, and renegotiating existing reimbursement rates.

Essential Duties & Responsibilities:

• Business Development & Payer Contracting: Proactively establish high-level relationships with decision-makers at managed care organizations (MLTCs, commercial health plans, state, county, and federal entities) to negotiate and close new provider contracts enterprise-wide.
• Service Line Expansion: Lead targeted network development for specialized clinical offerings, including Home Infusion, Specialty Pharmacy, Personal Care (LHCSA), and Hospice services.
• RFP & Municipal Submissions: Lead the development, writing, and submission of municipal and county RFPs (including County Department of Social Services / DSS and NYA contract opportunities).
• Data-Driven Rate Negotiation: Analyze utilization metrics, financial data, and reimbursement methodologies to pitch data-backed cases for rate increases and revenue enhancement during contract renewals.
• Hands-On Contract Administration & Compliance: Directly manage the day-to-day lifecycle of all agreements, including clearing administrative backlogs, executing re-credentialing, auditing rate sheets, and ensuring full compliance with state/federal regulations.
• Relationship & Dispute Management: Serve as the primary point of contact for external payer representatives and internal departments (Billing/RCM, Intake) to resolve contract, credentialing, or rate-discrepancy issues.
• Performance Reporting: Monitor contract performance, track renewal timelines, and maintain reporting mechanisms to evaluate overall payer effectiveness.

Qualifications & Requirements:

• Education: Bachelor's degree in Healthcare Administration, Business, or related field required; Master's preferred.
• Experience: 5+ years of hands-on experience in healthcare contracting, managed care, or network development within home health, infusion, pharmacy, or health plan environments.
• Negotiation & Business Development Track Record: Proven ability to build relationships, open doors with health plan leadership, and negotiate favorable reimbursement terms.
• Analytical Skills: Strong financial acumen with the ability to leverage internal metrics and fee schedules during negotiations.
• Execution & Detail Focus: Willingness to be an active, hands-on individual contributor who manages all contract paperwork, re-credentialing, and administrative details directly.
• Regulatory Knowledge: Deep understanding of New York healthcare regulations, managed care principles, and DSS/county procurement processes.

SKILLS & COMPETENCIES:

(Focus on both technical and behavioral competencies)

• Ability to handle multiple tasks.
• Ability to solve problems.
• Computer literate in fiscal management and other database programs.
• Demonstrate trustworthiness and discrete disposition in carrying out regulatory tasks.
• Excellent written and oral communication skills. xhyhwjd
• Possesses excellent interpersonal skills and ability to work well with others.