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BlueSprig · 1 month ago

Director of Payer Relations and Contracting

Houston, TX

Contract

Onsite

Director/Executive

7+ years exp

BlueSprig is seeking a Director of Payer Relations and Contracting to lead payer contracting efforts across its ABA centers. This role involves managing the full lifecycle of payer agreements and collaborating with various departments to ensure sustainable reimbursement and access to services.

Child CareHealth Care

Responsibilities

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

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

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

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

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

Qualification

Managed care contractingPayer relationsNegotiation skillsFinancial analysisHealthcare administrationLeadershipCommunicationCollaborationMentoring

Required

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

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

Preferred

Advanced degree preferred

Behavioral health or ABA experience strongly preferred

Company

BlueSprig

Glassdoor3.3

At BlueSprig we’re on a mission to change the world for children with autism. The families and children we serve are at the heart of everything we do.

Founded in 2017

Houston, Texas, USA

1001-5000 employees