Payor Relations Jobs (NOW HIRING)

The Director of Payor Relations leads administration of contracts with managed care payors, ensuring favorable reimbursement terms and regulatory compliance. They analyze contract performance, model reimbursement structures, and oversee resolution of claims issues such as denials and underpayments to maximize revenue and minimize financial risk. The role also provides collaboration across functions to align payor strategies with organizational goals.

Summary of Essential Job Functions

The key responsibilities of the Director of Payor Relations include but not limited to:

Duties and Responsibilities

• Utilize contract management between the healthcare system and managed care payors, including commercial insurers and government programs.
• Review applications and pipeline.
• Work within record portals.
• Evaluate new and existing agreements, modeling reimbursement structures, and determining the financial and operational feasibility of proposed contract terms.
• Analyze contract performance by reviewing reimbursement rates, denial trends, and payor behavior; recommend strategic modifications to maximize revenue, improve contract yield, and minimize financial risk to the organization.
• Oversee the resolution of escalated payor issues, including underpayments, overpayments, and claim denials, ensuring adherence to contractual terms and timely recovery of revenue.
• Review and manage payor portals and records to ensure accurate claims processing, contract compliance, and proper reimbursement tracking.
• Collaborate with Revenue Cycle, Finance, Compliance, and Clinical Operations to align contract terms with billing practices, operational workflows, and regulatory requirements.
• Establish and maintain strong relationships with payors to support contract negotiations, performance improvement initiatives, and ongoing issue resolution.
• Contribute to organizational strategic planning by providing insights into payor mix, reimbursement trends, and value-based care opportunities.
• Evaluate healthcare reimbursement methodologies, including fee-for-service, bundled payments, and value-based care arrangements.

Professional Development

• Demonstrates the belief that addiction is a brain disease, not a moral failing
• Demonstrates hope, respect, and caring in all interactions with patients and fellow Team Members
• Establishes and maintains positive relationships in the workplace
• Can work independently and under pressure while handling multiple tasks simultaneously
• Makes decisions and uses good judgment with confidential and sensitive issues
• Deals appropriately with others in stressful or other undesirable situations

Qualifications

• 7+ years of experience in managed care and/or government contracting within a healthcare organization
• Demonstrated experience in contract negotiation with payers
• Strong knowledge of:
• Healthcare reimbursement methodologies
• Managed care contracting structures
• Healthcare economics
• Proven financial acumen with the ability to evaluate contract performance and impact
• Experience working with Medicaid, Medicare, Medicare Advantage, and Commercial payers
• Strong relationship management skills, both internal and external
• Excellent communication and negotiation skills
• Ability to work cross-functionally in a collaborative environment
• Strategic thinker with strong attention to detail and execution skills
• Bachelor’s degree required
• Strong organizational skills, sound judgment, and ability to make timely decisions

Preferred Experience

• Experience working on both payer and provider sides of contracting
• Background in behavioral health
• Experience with:
• Value-based contracting and risk-sharing arrangements
• Innovative pricing and reimbursement models
• Familiarity with facility-based and provider-based contracting
• Experience overseeing or partnering on credentialing processes
• Experience supporting M&A activities, including due diligence and payer integration
• Track record of working closely with revenue cycle, finance, and operations teams
• Established industry relationships with regional or national payers
• Advanced degree (e.g., MBA, MHA) preferred

Physical Requirements and Working Conditions

The physical demands described here are representative of the requirements that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions to the extent such accommodation does not create an undue hardship on the business.

• A variable workload, periodic high activity level.
• Vision adequate to read correspondence, computer screen, forms, etc.
• Sit for long periods of time, some bending, stooping and stretching
• Speaking and hearing ability sufficient to communicate effectively by phone or in person at normal volumes
• Keyboarding for long periods of time

BHG is an equal opportunity, affirmative action employer providing equal employment opportunities to applicants and employees without regard to race, color, religion, age, sex, sexual orientation, gender identity/expression, national origin, protected veteran status, disability status, or any other legally protected basis, in accordance with applicable law.