Director of Payor Relations

About Stella Mental Health

Stella Mental Health is a leading provider of breakthrough mental health treatments for depression, PTSD, and anxiety. We use cutting-edge modalities, such as ketamine infusions, intranasal esketamine (Spravato), transcranial magnetic stimulation (TMS), and Stellate Ganglion Block (SGB) to help our patients achieve lasting relief. We are a community of compassionate professionals who support our patients and each other throughout their healing journey.

Position Summary:

As the Director of Payor Relations, you will be a pivotal leader responsible for the strategic oversight and execution of all aspects related to payor relationships, including credentialing, payor contracting, and revenue cycle management (RCM). Your primary focus will be to ensure our providers are efficiently and compliantly enrolled, contracted, and reimbursed across all our markets. This role demands a strategic thinker with deep expertise in navigating the complexities of payor landscapes and credentialing, optimizing financial performance, and fostering strong external partnerships. You will drive operational excellence in our payor interactions and play a crucial role in our continued growth and success, particularly as we integrate new clinics.

Top Priorities:

• Spearhead the implementation of delegated credentialing programs in alignment with NCQA and URAC standards.
• Develop and execute strategies to optimize our entity structure and strengthen our positioning with payors across all regions.
• Drive the seamless integration of billing processes across the organization to enhance collections and overall revenue cycle efficiency.

Responsibilities:

1. Credentialing & Compliance:

• Take ownership of the complete provider credentialing lifecycle, ensuring timely initial enrollment and ongoing re-enrollment with all relevant payors.
• Champion the development and implementation of efficient and automated credentialing workflows, including the establishment and management of delegated credentialing programs.
• Guarantee strict adherence to all applicable federal, state, and commercial payor credentialing regulations and guidelines.
• Maintain the highest level of accuracy in provider data across all credentialing platforms and our Electronic Medical Record (EMR) system, Athena, including accurate schedule setup.

2. Payor Contracting & Strategic Relations:

• Lead strategic initiatives to expand and optimize our delegated credentialing capabilities, ensuring alignment with NCQA and URAC standards to streamline processes and enhance payor relationships.
• Direct the overall payor contracting strategy, encompassing negotiations for optimal rates and terms, timely renewals, and proactive identification of opportunities for improvement.
• Continuously monitor and interpret evolving payor reimbursement trends and regulatory changes impacting our operations across all markets, including Utah.
• Ensure all payor contracts are strategically aligned with our organizational financial objectives, the scope of our clinical services, and our overarching growth strategy.
• Establish and maintain a centralized and well-organized database of all payor contracts, fee schedules, and critical reimbursement terms for easy access and analysis.

3. Revenue Cycle Management Oversight:

• Provide strategic leadership and direction to the revenue cycle function, with a strong emphasis on maximizing collections, proactively minimizing claim denials, and ensuring consistent and timely reimbursement.
• Uphold ethical and compliant billing practices while actively seeking opportunities to enhance reimbursement through process improvements, effective front-end collaboration with clinical teams, and robust internal controls.
• Proactively identify and analyze trends in claim denials and underpayments to inform operational adjustments, enhance internal strategies, and guide our engagement with payors.
• Utilize key performance indicators (KPIs) to rigorously monitor financial performance across the revenue cycle and collaborate closely with clinic teams to implement data-driven improvements in revenue outcomes.

Cross-Functional Collaboration:

• Foster strong collaborative relationships with clinical operations, finance, and executive leadership to ensure seamless alignment between payor relations strategies and broader organizational goals.
• Serve as the internal subject matter expert and primary escalation point for all credentialing, contracting, and revenue cycle-related challenges and inquiries.
• Provide exceptional team leadership across the credentialing, payor contracting, and RCM functions, including clearly defining priorities, conducting regular and productive weekly meetings, and actively managing team performance and development.
• Partner closely with the Chief Operating Officer (COO) to implement strategic initiatives across all operational functions, with a focus on building a scalable infrastructure to support future growth.

Qualifications & Experience:

• Bachelor’s degree in Healthcare Administration, Business Administration, or a closely related field.
• A minimum of 5 years of progressive leadership experience in credentialing, payor contracting, and/or revenue cycle management within a healthcare organization. Strongly preferred: Experience within a multi-site behavioral health environment.
• Proven track record of success in managing complex payor negotiations and implementing delegated credentialing programs.
• Comprehensive understanding of Medicare, Medicaid, and commercial payor requirements and regulations.
• Hands-on experience working with Athena or other comparable Electronic Medical Record (EMR) and Revenue Cycle Management (RCM) platforms.

At Stella Mental Health, we believe that diversity, equity, and inclusion are essential values that enrich our work environment and enhance our ability to serve diverse communities. We strive to integrate these values into every aspect of our organization, from hiring and training to policies and practices. We recognize that we have a responsibility to foster a culture of respect, empathy, and collaboration among our team, patients, and partners. Our vision is to be a leader in delivering patient-centered care that respects and celebrates diversity, promotes equity and inclusion, and improves health outcomes for all.