- Develop and execute a regional payer strategy aligned with enterprise goals for access, rate performance, and network positioning
- Own the full contracting lifecycle for assigned payers and markets, including opportunity assessment, proposal development, negotiation, redlining, and execution of new, renewal, and amended agreements
- Prioritize payers and products based on volumes, out-of-network exposure, and strategic growth needs
- Identify opportunities for improved terms, including rate optimization, escalators, modifiers, site-of-service and telehealth rules, and administrative simplification
- Maintain an accurate view of regional contracts and key financial and operational terms
- Track performance against contracted terms, including allowed amounts, denial patterns, and under/overpayments
- Drive renegotiation strategies, corrective actions, and payer escalations
- Serve as primary relationship owner for regional payer partners
- Lead regular business reviews addressing performance, operational issues, and new program opportunities
- Advocate for ABA-specific needs and collaborate on value-based programs, quality incentives, and alternative payment models
- Partner with Regional Operations Leaders to shape contracting priorities based on center-level needs
- Support new site openings, expansions, and acquisitions by securing payer participation, rates, and timelines
- Guide operations, intake, and scheduling teams on payer-specific rules, coverage, and authorization requirements
- Work with Growth/Business Development teams on RFP/RFI responses and partnership opportunities
- Partner with Legal, Compliance, and Risk on regulatory and policy alignment
- Prepare summaries and presentations for senior leadership
- Mentor and support Contract Managers and analysts
Requirements
- Bachelor’s degree in Business, Healthcare Administration, Finance, Public Policy, or related field required
- 7+ years of experience in managed care contracting, payer relations, or growth functions within healthcare
- Behavioral health or ABA experience strongly preferred
- Demonstrated success negotiating commercial and/or Medicaid agreements, including complex reimbursement and performance-based structures
- Strong financial and analytical skills
- Experience with rate modeling, scenario analysis, and interpretation of claims data
Demonstrates expertise in managed care contracting and payer relations, with a strong focus on negotiation, financial analysis, and strategic growth within the healthcare sector. Proven ability to lead contract lifecycle management and advocate for value-based programs and quality incentives.
Highest-signal resume keywords
- Managed Care Contracting
- Payer Relations
- Negotiation of Commercial Agreements
- Financial Analysis
- Rate Modeling
Hard Skills
- Contract Lifecycle Management
- Proposal Development
- Rate Optimization
- Claims Data Interpretation
- Scenario Analysis
Soft Skills
- Relationship Management
- Mentoring
- Collaboration
Industry Keywords
- Healthcare Administration
- Behavioral Health
- ABA
- Performance-Based Structures
- Alternative Payment Models
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Director of Payer Relations – Contracting Arbeitgeber: Jobtailor
Als Front Office Supervisor in unserem dynamischen Team bieten wir Ihnen die Möglichkeit, in einem unterstützenden und freundlichen Arbeitsumfeld zu wachsen. Wir legen großen Wert auf die berufliche Entwicklung unserer Mitarbeiter und bieten regelmäßige Schulungen sowie die Chance, Verantwortung zu übernehmen. Unsere Lage ermöglicht es Ihnen, Teil einer lebendigen Gemeinschaft zu sein, während Sie gleichzeitig die Standards unseres Franchise-Partners einhalten und unseren Gästen einen unvergesslichen Aufenthalt bieten.
