Director, Payer Policy Relations

The Director, Payer Policy Relations is responsible for leading strategic engagement with payers and ensuring policy compliance across all payer types, including Commercial, Medicaid, and Medicare. This role requires staying current with evolving payer policies and implementing necessary changes to maintain compliance. The Director will manage responses to Special Investigation Unit (SIU) inquiries and refund requests, ensuring timely and accurate resolution. Serving as a key liaison, the Director will facilitate collaboration between Legal, Compliance, Managed Care, Clinical, and other departments to support organizational goals and optimize payer relationships.

Essential Duties and Responsibilities:

• Policy Analysis and Interpretation:Monitor and interpret payer policies and regulatory changes.Thoroughly research and analyze payer policies, guidelines, and regulationsUnderstand the nuances of different payer types (commercial, government, etc.) and their specific requirementsEnsure compliance with payer rules and regulationsAssist in the development of new or improved policies and processes to optimize reimbursement and patient access as well as evaluate the effectiveness of existing policies and processes and recommend changes.
• Reimbursement Optimization: Identify and address reimbursement issues, including claim denials and payment delays.Develop strategies to improve reimbursement rates and reduce financial losses.Analyze data to identify trends in denials and develop appeals strategies.Analyze payer data to identify trends, measure the impact of policies, and develop and maintain reports and dashboards to track key performance indicators.
• Coverage Advocacy: Advocate for positive coverage decisions from payers, particularly for new or emerging technologies and treatments.Develop and present evidence-based materials to support coverage requests.
• Relationship Management: Build and maintain relationships with key payer contacts and stakeholders.Collaborate with internal teams (e.g., government affairs, compliance, managed care, clinical) to align with payer engagement strategies.
• Communication and Collaboration: Communicate policy changes and updates to internal stakeholders.Collaborate with other departments (e.g., clinical, revenue cycle) to implement policy changes and improvements.

Successful Candidates will Possess:

• Bachelor’s Degree in Business, Finance, or related discipline required
• A minimum of 10 years of experience in payer relations, contracting, and/or revenue cycle leadership required
• Experience in a laboratory or diagnostic testing environment is highly preferred
• Competencies/Skills required:Deep expertise in CPT, ICD-10, HCPCS coding systems, and denialsStrong working knowledge of payer portals, appeals workflows, and EMR/LIS platformsExceptional analytical, organizational, and communication skillsProficient in Excel and familiar with data visualization/reporting tools (Tableau, Power BI, or equivalent platforms)

Aegis Sciences Corporation is an Equal Opportunity Employer