The Vice President of Payor Relations is responsible for developing and executing the company’s national and regional strategy for payor contracting, credentialing, and operational engagement. This executive leader will oversee all third-party payor relationships, including negotiation of contracts, resolution of systemic claims and credentialing issues, and optimization of payor-related processes. Reporting to the SVP of Insurance Services, the VP will drive outcomes that improve reimbursement, streamline onboarding, and support the company’s growth and operational goals.

Key Responsibilities

1. Payor Strategy & Contracting

• Lead negotiations and management of all commercial and government payor agreements.
• Develop strategies to enhance reimbursement, optimize fee schedules, and expand in-network participation.
• Align payor contracting with enterprise growth, clinical expansion, and revenue goals.

2. Payor Relationship Management

• Build and maintain strong executive-level relationships with key payors.
• Serve as the primary point of escalation for systemic issues related to claims, denials, authorizations, and billing.
• Collaborate with internal teams to address payor policy changes and resolve operational barriers.

3. Credentialing Oversight

• Oversee credentialing processes to ensure timely and accurate provider enrollment with payors.
• Work closely with credentialing and legal teams to reduce cycle times and improve compliance.
• Establish and monitor credentialing KPIs, ensuring readiness for new site or provider launches.

4. Operational Excellence

• Partner with revenue cycle, technology, and operations teams to optimize payor-related workflows.
• Develop and implement scalable solutions to streamline processes related to payor rules, billing requirements, and enrollment timelines.
• Lead initiatives to improve internal coordination across departments impacted by payor relationships.

5. Performance Management & Reporting

• Establish and track key performance indicators (KPIs) for payor performance, contract ROI, and credentialing timelines.
• Use data analytics and reporting tools to monitor trends, underpayment activity, and credentialing bottlenecks.
• Deliver insights and recommendations to executive leadership on payor trends and contract opportunities.

6. Leadership & Talent Development

• Build, lead, and mentor a high-performing team of professionals in payor contracting, credentialing, and operational support.
• Promote a culture of accountability, innovation, and continuous improvement.

Qualifications

Education

• Bachelor’s degree required; Master’s degree in Healthcare Administration, Business, or related field preferred.

Experience

• 10+ years of progressive leadership experience in payor relations, managed care contracting, and/or credentialing operations, dental and medical.
• Strong experience with commercial and government payor negotiations in multi-site, multi-state healthcare organizations.
• Familiarity with dental, ambulatory, or physician group models preferred.
• Demonstrated success leading teams and resolving complex operational issues.

Skills & Competencies

• Strategic thinker with the ability to translate vision into execution.
• Advanced negotiation skills and business acumen in healthcare contracting.
• Deep understanding of payor requirements, credentialing processes, and regulatory compliance.
• Strong leadership presence with the ability to influence cross-functional teams and senior stakeholders.
• Excellent communication and relationship-building skills.
• Data-driven approach to decision-making, performance monitoring, and reporting.
• Proficient in RCM platforms, credentialing systems, and analytics tools.

Preferred Attributes

• Results-oriented and proactive in solving complex challenges.
• Comfortable operating in high-growth and fast-paced environments.
• Collaborative, transparent, and adaptable leadership style.
• Committed to operational excellence and service delivery.

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