Vice President of Payor Relations
InterDent Service Corporation provides comprehensive dental support and administrative services to over 165 dental practices, employing more than 400 dentists across eight states. These practices, including the Gentle Dental® and Blue Oak Dental® brands, offer high-quality, patient-centered dental care. Additionally, InterDent operates Capitol Dental Care (CDC), a capitated, value-based care program in Oregon. CDC partners with coordinated care organizations to deliver dental services under the Oregon Health Plan, focusing on preventive care and improving both oral and systemic health for children and low-income patients since 1994.
Position Summary
The Vice President of Payor Relations is accountable for securing optimal compensation and contractual terms for supported dental offices. This involves analyzing and prioritizing negotiation opportunities, strategizing plan participation, leveraging network relationships (including leased networks), and serving as a subject-matter expert on payor contracting and fee schedules. In partnership with senior leadership, the Vice President of Payor Relations guides the organization in maximizing revenue performance and ensuring strategic, mutually beneficial payor partnerships. In aligning with our business strategies and in order to succeed in this position, the selected candidate must be capable of demonstrating innovative solutions to move beyond historical Payor-Provider roles to adjust to the dynamics of the current and future dental-services models, including value based care initiatives, medical-dental integration and instilling the quadruple aim.
Key Responsibilities
- Analyzing and prioritizing payor negotiation opportunities
- Function as the business owner of the opportunity model that supports quantification and prioritization of payor negotiation opportunities.
- Understand and drive the logic inside the model, including continually enhancing and refining the usability and outputs.
- Leverage third party data (purchased and otherwise obtained) to enhance the model and results.
- Payor Negotiations & Contracting
- Understand dynamics of various plan types (PPO, HMO, etc.) and pursue the best opportunities.
- Facilitate negotiation packets designed to get targeted payors into selected negotiations.
- Establish and sustain ongoing negotiation cycles with existing payors to obtain favorable fees and contractual language.
- Identify and assess emerging payor network opportunities; present data-driven insights on feasibility and projected value.
- Evaluate underperforming payors with substandard fee structures, limited membership, or suboptimal terms and conditions; recommend continuation, renegotiation, or termination.
- Continually review existing payor agreements to ensure compliance, minimize provider risk, and maintain best-in-class contractual terms.
- Understand both direct and indirect (leased) network relationships and their reimbursement implications.
- Develop and execute a strategic plan to identify partnership opportunities by state or region to increase patient referrals, market share and/or reimbursements. Review opportunities in Medicare Advantage plans, state Medicaid programs outside of Oregon and other growth avenues.
- Payor Relationship Management
- Foster and maintain strong relationships with payors, conducting scheduled performance reviews to identify opportunities for enhanced collaboration and reimbursement.
- Provide expert guidance to internal teams (e.g., Operations, Revenue Cycle) on payor policies, protocols, and claim-related processes.
- Continually track performance with payors and advise other functional areas on opportunities for improvement.
- Serve as the escalation point for multi-practice payor-related concerns, coordinating cross-functional solutions.
- Operational & Compliance Support
- Promote and drive adoption of operational efficiencies (e.g., EDI, EFT, ERA, web portals, delegated credentialing) in alignment with industry best practices.
- Coordinate with the Compliance Department to resolve patient grievances, ensuring prompt and fair resolutions.
Education & Experience
- Minimum of a bachelor’s degree in business, Healthcare Administration, or related field (preferred). Master’s degrees are favorable.
- Extensive knowledge of various dental benefit models (FFS, Indemnity, PPO, EPO, DHMO, Discount, Medicaid, Medicare Advantage).
- Ideally has at least 10 years’ experience in the dental industry, including 5-10 years of direct provider-side experience.
- Experience working with dental insurance payors (or within a payor organization) is highly advantageous.
- Equivalent combinations of education and relevant experience will be considered.
Travel Requirements
- Approximately 10–25% travel, with occasional overnight stays as required for payor or affiliate visits and conferences. Additional travel may be required if located.
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.
For further information, please review the Know Your Rights notice from the Department of Labor.