Director of Contracting & Payor Relations

United StatesRemoteFull-timeexecutive

Other

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Quick Summary

Key Responsibilities

Develop and manage enterprise-wide payor strategies covering commercial dental PPO plans, leased and umbrella networks, medical plans for oral surgery, and government programs.

Requirements Summary

The ideal candidate combines extensive payor contracting expertise with strong financial modeling capabilities, commercial negotiation skills, and experience managing complex healthcare networks.

Technical Tools

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The Director of Contracting & Payor Relations will lead enterprise-wide payor strategy for a growing, multi-location dental healthcare organization. Reporting directly to the Chief Financial Officer, this leader will oversee contract negotiations, network participation decisions, and strategic relationships with major dental and medical payors. The role combines financial analysis, commercial negotiation, and operational collaboration to improve reimbursement and drive sustainable revenue growth. You will build the frameworks, performance scorecards, and negotiation processes needed to optimize payor relationships across multiple locations and specialties. Working closely with executive leadership, clinical teams, and revenue cycle professionals, you will influence key business decisions and support expansion through acquisitions. This is an opportunity to shape a critical function, deliver measurable financial results, and contribute directly to the organization's long-term growth.

The Director of Contracting & Payor Relations will establish and execute the organization's payor strategy, optimize contractual performance, and strengthen relationships with insurance carriers and network partners. Key responsibilities include:

Develop and manage enterprise-wide payor strategies covering commercial dental PPO plans, leased and umbrella networks, medical plans for oral surgery, and government programs.
Lead fee schedule negotiations and renegotiations with national and regional carriers, including specialty-specific reimbursement schedules.
Evaluate direct contracting versus leased network participation and recommend out-of-network or contract termination decisions using revenue projections and patient retention modeling.
Create and maintain payor performance scorecards tracking patient volume, net collection rates, write-offs, and reimbursement for key procedure codes.
Model the financial impact of proposed contracts and provide rate assumptions for budgeting, forecasting, and board reporting.
Coordinate provider credentialing and payor enrollment to ensure dentists are in network before seeing their first patients.
Serve as the senior escalation point for systemic claim denials, underpayments, reimbursement downgrades, and payor recoupment demands.
Assess payor agreements during acquisition due diligence and lead contract integration following acquisitions.
Collaborate with Revenue Cycle, Operations, Clinical Leadership, and Compliance teams to improve payment accuracy, educate front-office teams, and communicate payor policy changes.
Monitor state insurance regulations and assess their implications for contractual arrangements across operating markets.

Requirements

~1 min read

The ideal candidate combines extensive payor contracting expertise with strong financial modeling capabilities, commercial negotiation skills, and experience managing complex healthcare networks. They should be comfortable advising senior executives and translating contractual decisions into measurable business outcomes. Required qualifications include:

Bachelor's degree in Business, Finance, Healthcare Administration, or a related field; an MBA or MHA is an advantage.
At least 8 years of experience in payor contracting, network management, or managed care, including a minimum of 3 years leading negotiations.
Hands-on experience negotiating dental PPO fee schedules for a multi-location organization or working on the payor or network side.
Working knowledge of CDT coding, dental benefit design, leased networks, and claims adjudication.
Strong Excel-based financial modeling skills and a demonstrated track record of securing and documenting reimbursement rate improvements.
Experience with provider credentialing and enrollment processes, including CAQH.
Previous experience in a dental support organization (DSO), multi-site healthcare environment, or private equity-backed organization is preferred.
Experience with acquisition integration, medical billing for oral surgery, or Medicaid dental programs is a plus.
Strong analytical and communication skills, with a data-driven approach and the confidence to present recommendations to CFOs, executive leadership, and board members.