Director – Payer Relations

Director – Payer Relations

Requirements

• Minimum of 10+ years of experience in healthcare IT, payer relations, Revenue Cycle Management, or connectivity infrastructure, with 3+ years in a strategic leadership role.
• Strong understanding of HIPAA EDI transactions (e.g., 837, 835, 270/271), clearinghouse processes, and payer-provider data exchange models
• Experience with FHIR and CMS interoperability rules.
• Proven experience of developing and scaling successful partnerships and payer connectivity networks, either at a health tech company, clearinghouse, or payer.
• Strong experience building payer networks, either at a health tech company, clearinghouse, or payer.
• Deep understanding of healthcare business models, including providers, payers, digital health, and value-based care.
• Ability to work with all levels of individuals as a team player or in leadership role.
• Excellent critical thinking and logical reasoning abilities.
• Excellent written and verbal communication skills as well as strong presentation skills.
• Proficient with Microsoft Office, with emphasis on Word, Excel and PowerPoint;
• Understanding and managing expectations, ability to drive win-win solutions, building and maintaining customer relationships.
• Self-motivated with strong organizational/prioritization skills and ability to multi-task with close attention to detail.
• Ability to thrive in fast-paced and changing environments.

Responsibilities

• Build and maintain strong relationships with payers, understanding their needs, expectations, and market trends.
• Establish and maintain strategic relationships with payers, clearing houses, and industry consortiums.
• Lead negotiations and agreements with new and existing payer partners.
• Analyze payer connectivity performance metrics and transaction response metrics (e.g., payer not responding, member not found) and lead initiatives to improve outcomes.
• Ensure high availability and reliability of payer transactions.
• Gather feedback cross-functionally on connectivity and transaction response metrics to drive enhancement requests and prioritization.
• Develop and lead the strategy for expanding payer and clearinghouse integrations across all lines of business.
• Identify opportunities to strengthen payer connectivity, reduce claims lifecycle friction, and improve provider-payer data flow.
• Negotiate and manage contracts with payers, ensuring favorable terms and compliance with regulatory requirements.
• Monitor payer requirements, CMS mandates, and interoperability trends to inform roadmap planning.
• Represent the company in payer and industry working groups, such as WEDI or CAQH.
• Maintain compliance with Inovalon’s policies, procedures and mission statement.
• Adhere to all confidentiality and HIPAA requirements as outlined within Inovalon’s Operating Policies and Procedures in all ways and at all times with respect to any aspect of the data handled or services rendered in the undertaking of the position;
• Fulfill those responsibilities and/or duties that may be reasonably provided by Inovalon for the purpose of achieving operational and financial success of the Company;
• Uphold responsibilities relative to the separation of duties for applicable processes and procedures within your job function;
• We reserve the right to change this job description from time to time as business needs dictate and will provide notice of such.

Preferred Qualifications

• Bachelor’s degree or equivalent work experience.
• Master’s degree preferred.