Job Details

Senior Manager, Payor Relations & Regulatory Affairs

  2025-09-06     Gateway Recruiting     San Francisco,CA  
Description:

Overview

The Opportunity: This position provides regulatory compliance leadership for the business, ensuring the policies, procedures, and practices of the business remain compliant to regulatory and contract requirements. Location: Orlando, FL.

Responsibilities

  • Directly manages the team responsible for following: CMS enrollment, Medicaid enrollment, state licenses, Joint Commission accreditation, payor contract review, and quality systems
  • Develop and participate in setting compliance strategies and initiatives
  • Oversee business policies, processes and programs to ensure business remains compliant to regulatory and contract requirements
  • In charge of audits and regulatory inspections
  • Responsible for ensuring business licenses are up to date and compliant with all geographies the business operates within
  • Provides oversight into the complaint management process and reporting requirements
  • Leads organization through all activities required to maintain Joint Commission accreditation
  • Monitors relevant regulations for changes applicable to business and ensure policies and procedures are updated as needed
  • Ensure timely processing of sales contracts and Medicaid enrollments
  • Negotiate and draft high-value complex contract terms and conditions in accordance with corporate policies
  • Acts as a Contract Administration lead and be able to train new hires
  • Analyze potential risks that contract changes may pose to the organization and provide a solution
  • Present and explain contract conditions and details to customers, business partners, and management
  • Work with different levels of personnel within an organization to analyze and solidify an overall contract strategy
  • Interface with internal fulfillment groups and distributors to establish working relationships, assure proper end-user pricing and contract effective dates are loaded
  • Perform other duties & projects assigned
  • Understands and is aware of the quality consequences which may result from the improper performance of their specific job

Required Qualifications

  • Demonstrated ability of effective and constructive communication across departmental disciplines while pursuing contract department goals
  • Experience and competency with EMR systems, Government and Insurance Portals
  • Must have excellent oral, written and interpersonal communication skills
  • Must have customer service attitude & good computer skills (Microsoft Word, Excel, Outlook, etc.)
  • Self-starter and a multi-tasker
  • Ability to work in a high volume, dynamic team environment

Preferred Qualifications

  • 10+ years of relevant experience
  • Bachelor's degree or equivalent experience
  • Experience with regulations pertaining to being a service provider for durable medical equipment (DME) and / or an independent diagnostic test facility (IDTF) strongly preferred

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