Director of Payor Contracting

Multi-State and Multi-Site Dermatology Group Seeks Director of Payor Contracting & Partnerships

Optima Dermatology is recruiting a Director of Payor Contracting & Partnerships to continue Optima’s commitment to make payor partnerships a strategic advantage for our practice. This full-time position is based out of our Portsmouth, NH corporate office.

Position Details:

Our philosophical approach toward Payors at Optima is one of collaboration to bring our patients and our Payor partners’ members value, including our unique approach toward increasing access to the highest quality care and providing complex MOHS surgeries in an office setting that are typically done in an HOPH. We have built strong payor relationships by demonstrating the value we add through increased access to high quality dermatologic care in underserved areas and performing complex surgeries at a fraction of the cost of alternative settings. The shared goal between Payors and Optima of early detection and treatment affords better patient outcomes with less invasive procedures and can significantly reduce healthcare costs for both patients and Payors. 

In this role, you will function as the primary liaison between Optima and our Payor partners. This includes leading all negotiations and contract language review, relationship development, maintenance, management, and fostering innovation in population health with health plan partners across all business lines.

The role also requires significant technical expertise, as you will execute all analytics related to market position, pricing models and fee schedule analysis, and continuously enhance Optima’s database, processes, and analytics for payor contracting.

Responsibilities:

Deals/Negotiations

• Develop, maintain, and manage strong and collaborative relationships with all Payors.
• Develop and continuously improve Optima’s value proposition presentation materials for all Payor related discussion, both internal and external.
• Maximize in-person meetings, including site visits, open houses, and any other opportunity to connect with payor partners.
• Outreach periodically with practice updates, especially during non-negotiation periods.

• Initiate and lead negotiations with payor partners.
• Model Payor position in each market, accounting for revenue, utilization, provider type, and lines of business, and product differentials.
• Map out a clear negotiation strategy for each deal in advance of discussions with Payors.
• Review and negotiate contracts through to signature (including managing Optima leadership review and approval), particularly for any terminations or contract extensions.

Other

• Maintain detailed notes of all communications with Payors, particularly contact details, communications (calls and emails), updated strategies on how to achieve goals, and planned next steps in our CRM (Salesforce).
• Utilize Asana for project management and prioritization of deals, goals, request intake and prioritization, and other action items and assignments to individuals on the Optima team.
• Manage any external consultant relationships in conjunction with Optima leadership as required.
• Review chargemasters following the completion of deal negotiations, and not less than every six (6) months to ensure charges are never less than highest contracted rate.
• Maintain detailed tracking of all Payor contract renewals and notices, and deal terms and update any time a deal is completed. Review on a weekly basis with Optima leadership.
• Track and report on department KPIs tracked monthly.
• Maintain contracts and fee schedules for all Payors.
• Plan deals for the next twenty-four (24) months with targets.

 Qualifications

• 4+ years of experience in an external facing role with strong interpersonal skills and proven ability to establish a rapport with external stakeholders

• Proven experience in payor contracting, either direct contracting or a supporting role required. Payor Network Management experience, strongly preferred
• Experience developing strategies with subsequent presentations and proposals
• Strong project lead/management skills
• Technologically savvy with the aptitude to learn new systems and processes that drive efficiencies. Examples include Salesforce (CRM), Asana (project management), Modernizing Medicine (practice management), Microsoft Office, including Excel (modeling), navigating SharePoints and other file management applications
• Expertise in producing detailed analyses, modeling, collecting data for negotiations; with the ability to design and produce data models, strongly preferred
• Highly organized and detail oriented, with Strong ability to manage to multiple deadlines and closing the loop with key stakeholders
• Strong work ethic; will get the job done, self-starter, energized by fast paced environment

About Optima Dermatology

At Optima Dermatology, our mission to revolutionize skin care is made possible by our world class team that is highly engaged, mission-driven, and inspired to set the new standard in dermatology. We are growing rapidly and looking for key team members who believe in our mission and want to make a difference in the lives of our patients. We foster a collaborative environment that is fun and hardworking and promise you will work alongside amazing colleagues you are proud to call your teammates.