Cibolo Health · 2 days ago
Director of Payer Relations
United States
Full-time
Remote
Lead/Staff, Director/Executive
5+ years expCibolo Health is seeking a highly skilled, mission-driven, Director of Payer Relations to support, negotiate, implement and administer payer agreements across Value-Based Care and Fee-for-Service arrangements. This role focuses on ensuring contractual compliance, operational clarity and financial sustainability while supporting member networks transition toward value-based payment models.
CommunitiesHealth CareHospital
Responsibilities
Lead and support negotiations with commercial and government payers for FFS and VBC agreements, consistent with applicable regulatory requirements
Draft, review, and administer payer contracts and amendments to ensure clarity of terms, alignment with quality and performance objectives, and compliance with governing laws and regulations
Maintain accurate, organized records of contract terms, performance requirements, and payer communications
Support the development and administration of value-based arrangements such as shared savings, bundled payments, and other performance-based models that are payer-sponsored or payer-approved
Collaborate with clinical, quality, finance, and analytics teams to operationalize payer-defined quality measures, cost benchmarks, and reporting requirements
Monitor contract compliance, including quality reporting and performance timelines, and coordinate corrective actions as needed
Participate in payer meetings focused on quality improvement, care coordination, and program performance on behalf of the network, consistent with contractual scope and governance
Analyze reimbursement methodologies and model the financial implications of proposed payer arrangements
Assess financial performance and risk exposure under existing contracts and support mitigation planning where appropriate
Prepare performance dashboards and summary reports for internal leadership and governance committees (e.g., Business Integration, Clinical Integration, Care Coordination, Executive Leadership, and Board)
Work closely with internal teams (Clinical Operations, Quality, Finance, Analytics) to translate contract requirements into operational workflows
Serve as a central point of coordination between payers, participating network entities, and internal departments to address contractual, administrative, and performance-related questions
Support participating providers with escalated payer matters such as credentialing questions, reimbursement inquiries, and claims-related issues, while preserving payer and provider autonomy
Ensure contracting and performance activities align with federal, state, and payer-specific requirements, including CMS and Medicaid program rules
Stay current on evolving CMS models, ACO initiatives, and alternative payment methodologies relevant to network participants
Promote transparency, documentation, and compliance practices consistent with FTC and DOJ guidance applicable to clinically integrated and value-based arrangements
Qualification
Required
Bachelor's degree in healthcare administration, Business, Finance, or a related field
Minimum of 5 years of experience in payer contracting, healthcare finance, revenue cycle, or related roles
Working knowledge of Fee-for-Service reimbursement, including Critical Access Hospital (CAH) and Rural Health Clinic (RHC) payment structures, and value-based payment models (e.g., shared savings, pay-for-performance, bundled payments)
Strong analytical, negotiation, and written and verbal communication skills
Experience using data analytics tools and contract management systems
Preferred
Experience supporting value-based or performance-based arrangements within population health or network environments
Familiarity with CMS programs, Medicaid managed care, and commercial payer contracting requirements
Ability to manage multiple concurrent projects and payer relationships in a dynamic, growth-oriented environment
Benefits
Impact: Drive transformational change in rural healthcare through data-driven decision-making.
Innovation: Work with cutting-edge population health platforms and analytics tools.
Collaboration: Partner with state leaders, payers, and providers to create sustainable, high value rural health solutions.
Growth: Access opportunities for professional development, research, and leadership in population health management.
Company
Cibolo Health
Cibolo Health helps independent rural hospitals create networks with their peers to overcome the obstacles rural healthcare providers face.
2-10 employees
Funding
Current Stage
Early StageCompany data provided by crunchbase