Director of Payer Relations and Contracting

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 agreementsfrom strategy and targeting, through negotiation and execution, to implementation and ongoing performance management. The Director partners closely with Operations, Revenue Cycle, Finance, and Clinical Leadership to ensure that contracts support sustainable reimbursement, expand access to ABA services, and align with BlueSprig's quality and service standards.

Responsibilities

Regional Contracting Strategy & Execution

• 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: 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 rate optimization, escalators, modifiers, site-of-service and telehealth rules, and administrative simplification.

Portfolio Oversight & Performance Management

• Maintain a clear, accurate view of all contracts within the region, including effective dates, termination provisions, key financial and operational terms, and value-based components.
• Partner with Revenue 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 when contract performance or administrative practices negatively impact access or reimbursement.

Payer Relationship Management

• Serve as the primary relationship owner for regional payer partners, fostering collaborative, solution-oriented engagement.
• Lead regular business reviews with key plans to address performance, operational issues (auth, claims, credentialing), and new program opportunities.
• Advocate 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 ramp-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.
• Develop 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 related field required; advanced degree preferred.
• 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, including experience with rate modeling, scenario analysis, and interpretation of claims data.