Director, Payor Relations

COMPANY BACKGROUND

TVG-Medulla, LLC is a multi-site healthcare management organization, with an emphasis on providing managed services to chiropractic providers. Medulla provides managed services such as Sales & Marketing, Billing, IT, HR, and Finance to three chiropractic brands, operating under the names of Chiro One, MyoCore, and CORE Health Centers. Medulla is comprised of 830+ employees, with corporate headquarters in Oak Brook, IL and 150+ clinic locations in Illinois, Indiana, Wisconsin, Missouri, Kansas, Kentucky, West Virginia, Texas, Oregon, Washington, and Alaska.

TVG-Medulla is a rapidly growing organization, realizing 30%+ growth year-over-year, through a combination of both organic and acquisitive growth. As the organization continues to expand and enter new markets, it seeks a strong strategic COO to lead the operations function. Our vision is to inspire and empower people in our communities to heal, live and function better.

General Description

We are seeking an experienced Payor Relations Director to join our organization. The successful candidate will be responsible for the strategic direction and negotiation process with payors to ensure patient access and sustainable pricing. Cultivates relationships to assist with problem resolution while positively advocating and removing barriers to access to ensure coverage and reimbursement.

Role Specific Responsibilities:

Evaluate networks and gaps, develop pricing strategies, including direct payor negotiations on terms and rates, addition of new products and services to existing contracts, ensuring contracts are maintained and contract terms are met.

Lead negotiations with payers to secure favorable reimbursement rates and terms.

Market access strategy development: Contributing to the development and execution of strategies to gain access to payer networks and maximize patient access to services.

Payer policy analysis: Monitor and analyze payer policies, coverage guidelines and reimbursement methodologies to identify potential challenges and opportunities. Educate leadership, revenue cycle and operations of these challenges and opportunities.

Quality management: Key knowledge of payor quality measurement tools. Collaborate with internal teams to coordinate strategy and understanding of financial and clinical implications.

Education and Qualifications:

• Bachelor's degree is required, advanced degree is preferred.
• Experience in payor negotiations
• Deep knowledge of healthcare, managed care strategy, pricing and medical reimbursement environment required.
• Proven ability of successfully managing complexity, solving problems and building strong relationships.
• Ability to work well independently as well as collaboratively; self-motivated and disciplined to meet deadlines in the context of competing priorities and projects; lead and work effectively with cross-functional teams