Director of Payer Relations

Key Responsibilities

• Payer Relations & Contract Management
• Own the full lifecycle of all payer contracts: negotiation, execution, renewal, and ongoing performance monitoring
• Analyze payer fee schedules and reimbursement rates across all contracts; identify underpayment gaps and drive renegotiation to improve rates
• Maintain and update the practice's chargemaster and fee schedules in the EHR/practice management system (AdvancedMD); ensure rates are accurate and current across all payers and service lines
• Conduct annual fee schedule reviews in partnership with Finance to ensure contracted rates remain strategically aligned with the cost of care
• Serve as the primary point of contact for all payer representatives; maintain direct, active relationships and know who to call to get things done
• Escalate and resolve complex payer disputes, wrongful denials, and underpayment issues that require direct payer intervention
• Write and oversee escalated appeal letters; ensure appeals are clinically supported, accurate, and submitted within timely filing requirements
• Monitor payer policy changes and communicate impacts to clinical, compliance, and billing teams proactively
• Fee Schedule Oversight
• Own fee schedule management end-to-end: negotiation, loading, maintenance, and reconciliation
• Audit reimbursements against contracted rates to identify systematic underpayments; initiate recovery and corrective action
• Track fee schedule performance across payers and present findings and recommendations to executive leadership
• Partner with Finance on chargemaster strategy to ensure billed charges reflect the appropriate markup above contracted rates
• Provider Credentialing & Enrollment
• Oversee the credentialing function with a dedicated credentialing team member handling day-to-day execution; own the standards, timelines, and outcomes
• Ensure all providers are credentialed and enrolled with relevant payers accurately and on time; hold the process to turnaround benchmarks that protect billing continuity
• Maintain an accurate credentialing database tracking licensure, certifications, DEA, malpractice coverage, and all expirables; manage renewals proactively, never reactively
• Coordinate credentialing timelines with recruiting, onboarding, and partner launch schedules to prevent credentialing gaps from becoming billing gaps
• Personally step in on complex enrollment issues, payer rejections, or credentialing disputes that require escalation
• Manage re-credentialing cycles and oversee responses to payer audits or corrective action requests related to provider enrollment
• Partner & Plan Launch Support
• Own revenue readiness for every new partner or plan launch: ensure the right contracts are in place, providers are credentialed, and systems are configured before the first claim is submitted
• Partner with Business Development, Operations, and Clinical teams during onboarding to map out the full billing setup: payer mix, covered services, fee schedules, authorization requirements, and billing rules
• Build and maintain a launch readiness checklist and timeline; flag risks early and drive cross-functional accountability to close gaps
• Build and maintain a launch readiness checklist and timeline; flag risks early and drive cross-functional accountability to close gaps
• Lead system configuration in AdvancedMD for new payers and partners: fee schedule loading, payer enrollment linkage, and claim routing
• RCM Oversight & Cross-Functional Leadership
• Serve as a strategic partner to the RCM Manager, providing guidance on denial trends, payer-related billing issues, and revenue performance
• Review RCM KPIs and dashboards regularly — clean claims rate, days in AR, denial rate, collection rate, net collection rate — and identify issues requiring payer-level intervention
• Escalation point for billing team on complex denials, payer disputes, and contract interpretation questions
• Collaborate with Clinical, Compliance, Legal, and Finance teams to align revenue cycle practices with organizational strategy and regulatory requirements
• Serve as the internal subject matter expert on behavioral health reimbursement, payer policy, and revenue cycle best practices
• Deliver regular reporting and strategic updates to the CEO and executive leadership on payer performance, contract outcomes, and revenue risks

Qualifications

• Bachelor's degree in Healthcare Administration, Finance, Business, or related field
• 7+ years of progressive RCM experience in healthcare, with at least 3 years in a leadership role
• Deep, hands-on experience in behavioral health payer contracting, fee schedule management, and payer relations
• Demonstrated track record of negotiating payer contracts and improving reimbursement rates
• Direct ownership of provider credentialing and payer enrollment processes
• Proficiency with EHR/practice management systems (AdvancedMD preferred) and clearinghouses
• Strong command of CPT, HCPCS, and ICD-10 coding in a behavioral health context
• Experience supporting partner or plan launches: contracts, credentialing, and system setup prior to go-live
• Comfort engaging payers directly — including making calls, writing appeals, and attending payer meetings
• Preferred Master's degree (MBA, MHA, or related)
• RCR, CHFP, CPAM, or equivalent RCM certification
• Experience with multi-state telehealth or virtual-first behavioral health organizations
• Experience with denial analytics platforms and RCM automation tools
• Experience building or scaling payer relations functions in a high-growth or startup environment

Core Competencies

• Technical: Payer contract negotiation and lifecycle management, fee schedule management and chargemaster strategy, provider credentialing and payer enrollment, behavioral health coding and compliance, denial management and complex appeals, EHR/billing platform proficiency (AdvancedMD), financial reporting and KPI analysis
• Leadership & Soft Skills: Strategic thinking with hands-on execution instincts, direct payer engagement and relationship management, executive communication and reporting, cross-functional collaboration and partnership, process improvement and operational discipline, team oversight and staff development, attention to detail and data integrity

What Success Looks Like

• Payer contracts are actively managed, regularly reviewed, and renegotiated when Marvin is being under-reimbursed
• Fee schedules are accurate, current, and loaded correctly in AdvancedMD across all payers at all times
• No provider goes unbilled due to a credentialing gap — enrollment is completed ahead of schedule, not behind it
• Every new partner or plan launches with contracts in place, systems configured, and the billing team ready to submit clean claims from day one
• Complex payer issues are resolved quickly because the right relationships exist and the Director is not afraid to use them
• The RCM team has a reliable escalation partner and a clear strategic direction on payer matters

Compensation Range

• $110K - $150K