Director of Payer Relations – Contracting

This is a fully remote position, open to applicants in Florida.

📋 Description

• Develop and implement a regional payer strategy that aligns with enterprise objectives for access, rate performance, and network positioning.

• Manage the complete contracting lifecycle for designated payers and markets, encompassing opportunity assessment, proposal creation, negotiation, redlining, and the execution of new, renewal, and modified agreements.

• Prioritize payers and products according to volumes, out-of-network exposure, and strategic growth requirements.

• Identify opportunities for enhanced terms, including rate optimization, escalators, modifiers, site-of-service and telehealth regulations, and administrative simplification.

• Keep an accurate overview of regional contracts and essential financial and operational terms.

• Monitor performance against contracted terms, including allowed amounts, denial trends, and under/overpayments.

• Drive strategies for renegotiation, corrective actions, and payer escalations.

• Serve as the primary relationship manager for regional payer partners.

• Conduct regular business reviews to address performance, operational challenges, and new program opportunities.

• Advocate for ABA-specific requirements and collaborate on value-based programs, quality incentives, and alternative payment models.

• Work alongside Regional Operations Leaders to define contracting priorities based on center-level needs.

• Assist with new site openings, expansions, and acquisitions by securing payer participation, rates, and timelines.

• Provide guidance to operations, intake, and scheduling teams regarding payer-specific regulations, coverage, and authorization requirements.

• Collaborate with Growth/Business Development teams on RFP/RFI submissions and partnership opportunities.

• Partner with Legal, Compliance, and Risk to ensure regulatory and policy alignment.

• Prepare summaries and presentations for senior leadership.

• Mentor and support Contract Managers and analysts.

⛳️ Requirements

• A Bachelor’s degree in Business, Healthcare Administration, Finance, Public Policy, or a related field is essential.

• Over 7 years of experience in managed care contracting, payer relations, or growth functions within the healthcare sector.

• Experience in behavioral health or ABA is highly preferred.

• Proven track record in negotiating commercial and/or Medicaid agreements, including complex reimbursement and performance-based structures.

• Strong financial and analytical abilities.

• Familiarity with rate modeling, scenario analysis, and claims data interpretation.

🏝️ Benefits

• Comprehensive health insurance coverage.

• Opportunities for professional development and career advancement.

• Flexible working hours and remote work options.

• A supportive and collaborative team environment.

• Competitive salary and performance-based incentives.