Director, Payer Relations

Overview: The Director, Payer Relations is responsible for managing and strengthening relationships with payers, clearing houses, and industry partners to support Inovalon's Business Unit. This role focuses on improving transaction performance, leading contract negotiations, and driving initiatives that enhance payer connectivity and reduce claims lifecycle friction. The Director, Payer Relations, will collaborate cross-functionally to analyze metrics, resolve issues, and contribute industry insights to inform strategic planning and ensure regulatory alignment.

Duties and Responsibilities:

• Strategic Partnership and Network Development:




• 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.




• Performance & Optimization:




• 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.




• Strategic Planning & Execution:




• 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.




• Contract Negotiation and Management:




• Negotiate and manage contracts with payers, ensuring favorable terms and compliance with regulatory requirements.




• Market & Industry Intelligence:




• 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; and

• We reserve the right to change this job description from time to time as business needs dictate and will provide notice of such.

Job 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.

Education:

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

Physical Demands and Work Environment:

• Sedentary work (i.e., sitting for long periods of time);
• Exerting up to 10 pounds of force occasionally and/or negligible amount of force;
• Frequently or constantly to lift, carry push, pull or otherwise move objects and repetitive motions;
• Subject to inside environmental conditions; and
• Travel for this position is expected to be less than 45%.