Job Description
Overview Sage Dental Partners is a leading Dental Service Organization (DSO) committed to innovation, excellence, and patient-centered care. The Senior Director of Payer Relations is responsible for the strategic development, negotiation, and ongoing management of all payer contracts across the dental service organization. This role leads payer strategy for commercial, Medicare Advantage, and state Medicaid programs, ensuring alignment with organizational objectives for growth, reimbursement optimization, and compliance with federal and state regulations.
The Senior Director will cultivate strong, long-term relationships with payers and internal partners, serving as the organization's subject matter expert on payer contracting, reimbursement methodologies, and policy interpretation.
Responsibilities Strategic Leadership & Partnership Development - Develop and execute the organization's payer strategy to ensure sustainable, market-competitive reimbursement models across all dental specialties (General, Orthodontic, Pediatric, Oral Surgery, and Specialty Care).
- Lead contract and fee schedule negotiations, renewals, and amendments with commercial and government payers.
- Establish strategic partnerships with payers to support network growth, reimbursement innovation, and value-based care initiatives.
- Collaborate with Operations, Clinical, and Finance leadership to align payer strategies with patient access, care delivery, and financial goals.
Contracting & Network Management - Oversee the negotiation, review, and execution of all payer agreements and related amendments.
- Manage payer onboarding and credentialing workflows in collaboration with the Credentialing and Enrollment teams.
- Ensure accurate fee schedule loading, maintenance, and validation in practice management systems.
- Develop and maintain payer performance dashboards to monitor reimbursement trends, rate changes, and operational impact.
Regulatory Compliance & Policy Oversight - Maintain comprehensive understanding of CMS regulations , including Medicare Advantage , CHIP , and state Medicaid programs affecting dental benefits.
- Serve as a policy liaison, interpreting and communicating payer, CMS, and state-level regulatory changes to executive and operational stakeholders.
- Partner with Legal and Compliance teams on payer audit responses, contract disputes, and government program participation requirements.
- Ensure all payer contracts and internal processes adhere to federal and state laws governing reimbursement and network participation.
Financial Strategy & Reimbursement Optimization - Collaborate with Revenue Cycle, Finance, and Analytics to identify reimbursement opportunities, contract leakage, and underpayment trends.
- Lead reimbursement modeling and financial impact analysis for new payer contracts, rate changes, and practice acquisitions.
- Contribute to annual budgeting and forecasting processes by providing contract-based revenue projections and rate updates.
- Monitor payer performance metrics such as rate realization, denial rates, and claim turnaround times.
Leadership & Team Development - Lead a multi-disciplinary team including Payer Relations Managers, Contract Analysts, and Credentialing Specialists.
- Foster a culture of accountability, collaboration, and continuous process improvement.
- Provide coaching, mentorship, and professional development opportunities to enhance payer relations expertise across the department.
Qualifications Qualifications - Bachelor's degree in Business, Healthcare Administration, Finance, or related field required; Master's degree preferred.
- Minimum 10 years' progressive experience in payer relations, managed care contracting, or healthcare reimbursement , with at least 5 years in a leadership role.
- Proven success negotiating dental payer contracts and managing multi-state network relationships.
- Deep understanding of CMS (Medicare/Medicaid) regulations and state-specific payer policy frameworks.
- Strong financial acumen and experience with fee schedule modeling, reimbursement analytics, and value-based care initiatives.
- Excellent negotiation, communication, and stakeholder management skills.
- Demonstrated ability to navigate complex multi-payer environments and support organizational growth initiatives.
- Remote position; some travel required (approximately 15-25%) for payer meetings, market visits, and industry conferences.
Performance Metrics - Contract renewal and reimbursement rate improvement year-over-year.
- Expansion of in-network participation and payer partnership opportunities.
- Timeliness and accuracy of contract implementation and fee schedule updates.
- Payer performance KPIs: turnaround time, rate realization, and denial resolution.
- Team performance, collaboration, and retention.
Job Tags
Contract work, Remote work,