National Director, Contracting & Payer Relations

Greater Purpose and Core Values:
Athletico’s Greater Purpose is to empower people, inspire hope and transform lives. We accomplish this by providing exceptional, progressive, and cost-effective fitness, performance and rehabilitative services through personalized care that emphasizes education and prevention of future injury. This is accomplished through building on our Core Values of one team, understanding our business, recognition, people-focused, accountability, continuous innovation and trust and integrity, which are the foundation for our unique culture.

Position Summary:
The Director, Payor Relations serves as an experienced managed care resource nationally to the organization leading, working alongside, and directing the core Fee-For-Service (FFS) Payor Relations contracting team that has responsibility for all payor contracts to ultimately ensure optimum reimbursement, value and performance leveraging strong relationships with all payors across all lines of business (e.g. Group health, Work Comp, Medicaid, Medicare Advantage, etc.). The role ensures accurate and timely reimbursement from insurance companies, government agencies, and vendors in addition to owning FFS contract negotiations end-to-end. The position acts as a liaison between Athletico and payors of all types and across all lines of business nationally, regionally, and locally.

Essential Duties and Responsibilities:

• Negotiate with as well as manage the core FFS team responsible for driving payor contracting negotiations across all lines of business to maximize growth and performance
• Develop and maintain relationships with third party payors, including commercial insurers, self-funded employers, government agencies, worker’s comp, etc.
• Manage staff to include selection, work allocation, training, coaching, and mentoring, problem resolution, performance evaluation, feedback, and corrective action
• Assist with credentialing and demographic updates of professionals in payor directories to ensure timely payment for services provided
• Work closely with legal, billing, and compliance on active negotiations, and, when necessary, resolve payment and/or billing disputes productively
• Stay abreast of industry changes to rules and regulations governing the payment for services provided to federally-funded patients
• Assist with contracting for employer services as a growing business segment for Value-Based Care

Qualifications:

• Education:
  • Bachelor’s degree required; Master’s or professional degree in Business or Health Administration preferred
    
• Work Experience:
  • Minimum 7 years’ experience in managed care contract negotiations from a payor or provider lens
  • Experience negotiating managed care contracts with spend or revenue in the tens of millions of dollars (US $) is strongly preferred
  • Experience with Ancillary (PT / OT) contracting is strongly preferred
  • Work Comp contracting experience preferred
  • Both payor (national or regional) and provider managed care contracting experience is a plus
  • Experience with Independent Physician / Provider Associations (IPAs), Clinically Integrated Networks (CINs), etc. is a plus
  • Minimum 5 years’ management level experience
    
• Certification/Licensure:
  • None required
    
• Knowledge and Technical Skills:
  • Strong Fee-For-Service managed care contracting proficiency; owning negotiations end-to-end, driving to completion on a deadline
  • Sound experience with managing and driving multiple in-flight negotiations at different stages
  • Strong understanding of government reimbursement
  • Proficient working knowledge of different provider reimbursement methodologies required (fee schedules, per diems, per visit rates, etc.)
  • Proficient in Microsoft 365, including Excel, MS Word, PowerPoint and Outlook
  • Proven ability to clearly organize and effectively convey information
  • Demonstrated ability to work effectively with both internal and external customers

Language Skills:

• Ability to read, write and speak English proficiently

Physical Demands: 
The physical demands and work environment described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.

• Ability to fulfill office activities including but not limited to remain stationary for extended periods of time (i.e., while working at a desk), stoop/kneel/crouch, travel around the office, communicate with others (verbal and written), and use fine motor skills including fine hand manipulation and keyboarding.
• Ability to see at close range, distance vision, peripheral vision, depth perception, and the ability to adjust focus
• Occasionally lift and/or move up to 20-25 pounds 

Work Environment: 

• Consistent with a standard office environment, noise level is low with little to no extraordinary environmental factors.

Athletico provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.