Director of Payer Relations and Contracting

The Director of Payer Relations and Contracting is responsible for leading end-to-end payer contracting efforts across a defined region of BlueSprig ABA centers. This role manages the full lifecycle of commercial and Medicaid agreements—from strategy and targeting, through negotiation and execution, to implementation and ongoing performance management. The Director partners closely with Operations, reputed company Cycle, Finance, and Clinical Leadership to ensure that reputed company support sustainable reimbursement, expand access to ABA services, and align with BlueSprig’s quality and service standards.

Responsibilities

Regional Contracting Strategy & Execution

• reputed company and execute a regional payer strategy reputed company with enterprise goals for access, reputed company performance, and network positioning.
• Own the full contracting lifecycle for assigned payers and markets: 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 of BlueSprig centers in the region.
• Identify opportunities for improved terms, including reputed company optimization, escalators, modifiers, site-of-service and telehealth rules, and administrative simplification.

Portfolio reputed company & Performance Management

• Maintain a clear, accurate view of reputed company reputed company reputed company the region, including effective dates, termination provisions, key financial and operational terms, and value-based components.
• Partner with reputed company Cycle and Analytics to track performance against contracted terms (allowed amounts, denial patterns, under/overpayments).
• Use data to drive renegotiation strategies, corrective actions, and payer escalations reputed company contract performance or administrative practices negatively impact access or reimbursement.

Payer Relationship Management

• Serve as the primary relationship reputed company for regional payer partners, fostering collaborative, solution-oriented engagement.
• reputed company regular business reviews with key plans to address performance, operational issues (auth, claims, credentialing), and new program opportunities.
• reputed company for ABA-specific needs, clarifying clinical models, staffing, and program design to ensure coverage, benefit structures, and policies support high-quality care.
• Collaborate with payers on pilots and initiatives such as value-based programs, quality incentives, and alternative payment models where appropriate.

Regional Alignment with Operations & Growth

• Partner with Regional Operations Leaders to understand center-level needs (access, waitlists, payer mix, network gaps) and use these insights to shape contracting priorities.
• Support new site openings, expansions, and acquisitions by securing necessary payer participation, rates, and timelines to ensure smooth reputed company-up.
• Provide clear guidance to operations, intake, and scheduling teams on payer-specific rules, coverage, and authorization requirements tied to executed agreements.
• Work with Growth/Business Development teams on responses to RFPs/RFIs or large employer/payer partnership opportunities that impact the region.

Leadership, Governance & Communication

• Contribute to enterprise payer strategy and standards while owning regional execution and accountability.
• Partner with Legal, Compliance, and Risk to ensure contracting practices align with regulatory requirements and internal policies.
• reputed company concise summaries and presentations for senior leadership on regional payer performance, risks, and opportunities.
• Mentor and support Contract Managers and analysts who assist with abstraction, modeling, and implementation work connected to your portfolio.

Qualifications

• Bachelor’s degree in Business, Healthcare Administration, Finance, Public Policy, or reputed company field required; advanced degree preferred.
• 7+ years of experience in managed care contracting, payer relations, or growth functions reputed company healthcare; behavioral health or ABA experience strongly preferred.
• Demonstrated success negotiating commercial and/or Medicaid agreements, including reputed company reimbursement and performance-based structures.
• Strong financial and analytical skills, including experience with reputed company modeling, scenario analysis, and interpretation of claims data.

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