Job Details

About Mindful Health Solutions

Mindful Health Solutions is a leading outpatient psychiatry group practice dedicated to freeing patients from the burden of mental illness. We are transforming outpatient mental healthcare by providing the most advanced, evidence-based treatments available, including Transcranial Magnetic Stimulation (TMS) therapy.

Job Description

Job Type: Full-time

Description:

About the Role: The Director of Payor Relations will lead strategy, negotiations, and relationship management with commercial payors to optimize reimbursement and expand access to care across Mindful Health Solutions' national footprint.

Responsibilities

1. Develop and implement payor relations strategy for the organization
2. Develop relationships with top commercial payor leadership, including leading regular, strategic conversations about access, quality, and cost
3. Devise an annual strategic contracting plan across Mindful Health Solutions' footprint; prioritize negotiations across states and service lines. Items included within the plan include, but are not limited to, expected pricing increases across each payor and partnership with clinical/operations for in-network strategies to drive patient volume.
4. Secure consolidated, nationwide contracts, whenever possible
5. Incorporate quality data, to include market reimbursement rates, to aid in increased reimbursement or increased volume capture
6. Present and receive leadership approval for the strategic contracting plan
7. Inform senior management of any payor sentiment for reimbursement of various procedures
8. Lead contract evaluation and strategy in existing and new states
9. Analyze current contracted rates against benchmarks and seek improved rates with a target to get the higher of keeping up with inflation or bridging the gap to market rates
10. Review and codify new target contract language
11. Quantify the financial impact of TIN changes, if applicable
12. Lead contract negotiation efforts to secure new contracts and/or rate amendments
13. Create data-based proposals for contract rate negotiations; analyze counterproposals
14. Coordinate credentialing and enrollment needs with the Vice President of RCM
15. Align scheduling guidelines based on contract inventory by TIN
16. Maintain accurate contract and rate inventory to ensure appropriate payment is received and contracts are at top of market
17. Maintain inventory of key contract terms and renewal dates
18. Maintain a database of payer contracted fee schedules and benchmarks
19. Partner with RCM and payment review software to identify payment concerns; collaborate with RCM to address underpayments with payer representatives
20. Payment review software to track, measure, and analyze payer reimbursements
21. Provide notice to payers for contracted rate increases and monitor the implementation of such
22. Evaluate utilization of and set self-pay rate bundles across the organization
23. Establish regular cadence with CFO and other leaders to discuss revenue recognition, payor contracting, and coding reimbursement perspectives
24. Coordinate contracting, scheduling guidelines, and payment review analysis
25. Monitor clinical guidelines, healthcare regulatory policies, and payer policies
26. Analyze potential or real impact on business
27. Develop strategies to enhance revenue and mitigate risk as policies evolve

Requirements

Must-Haves:

• 5+ years in payer relations, preferably with physician services or a top commercial payor
• Strong analytics, strategy, simplification, and presentation of complex data sets at the Board level
• Experience working in multi-site or national-scale payer relations
• Experience managing outsourced RCM and reporting
• Strong partnership with and knowledge of RCM functions, including fee-for-service billing

Nice to Have:

• Experience in private equity-backed healthcare organizations
• Established relationships within third-party organizations
• Experience within the mental health space

About Mindful Health Solutions: Mindful Health Solutions is a leading outpatient psychiatry group practice dedicated to freeing patients from the burden of mental illness. We are transforming outpatient mental healthcare by providing the most advanced, evidence-based treatments available, including Transcranial Magnetic Stimulation (TMS) and Esketamine therapy. TMS is a highly effective, non-invasive, FDA-cleared therapy for drug-resistant depression. Esketamine is an FDA-approved, prescription nasal spray for patients with treatment-resistant depression. Led by nationally recognized clinical experts in psychiatry and entrepreneurial healthcare business leaders, we offer compassionate, comprehensive mental healthcare. Our team-based work culture of learning, growth and innovation supports our core values of Accountability, Credibility and Transparency. Our medical clinics are specifically designed to provide our patients, practitioners, and employees with a modern, relaxed, people-centered experience.