Director of Payer Relations – Contracting

🔥 0 minutes ago

🐊 Florida – Remote

🐊 Florida – Remote

⏰ Full Time

🔴 Lead

👔 Director

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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BlueSprig

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2017

🏥 Healthcare

📚 Education

🌍 Social Impact

Healthcare • Education • Social Impact

BlueSprig is the premier therapy provider for children with autism, specializing in Applied Behavior Analysis (ABA) therapy services across the United States. They offer a range of compassionate, individualized care through programs that cater to different age groups, from early intervention for toddlers to specialized services for adolescents. With a commitment to enhancing outcomes for children, BlueSprig provides various therapy settings including center-based, home-based, community-based, and virtual options, ensuring that each child receives the personalized support they need to thrive.

📋 Description

• 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