Director of Payor Relations

TL;DR

Director of Payor Relations (Healthcare): Leads administration of contracts with managed care payors, ensuring favorable reimbursement terms and regulatory compliance with an accent on analyzing contract performance, modeling reimbursement structures, and resolving claims issues. Focus on maximizing revenue, minimizing financial risk, and aligning payor strategies with organizational goals.

Location: Remote (Dallas, TX, USA)

Company

hirify.global (BHG) operates treatment centers specializing in opioid addiction recovery.

What you will do

• Manage contracts with managed care payors, including commercial insurers and government programs like Medicaid and Medicare.
• Evaluate new and existing agreements, model reimbursement structures, and assess financial and operational feasibility.
• Analyze contract performance, denial trends, and payor behavior to recommend modifications for revenue maximization.
• Oversee resolution of escalated payor issues such as underpayments, overpayments, and claim denials.
• Review payor portals and records for accurate claims processing and compliance.
• Collaborate with Revenue Cycle, Finance, Compliance, and Clinical Operations teams.
• Build relationships with payors and contribute to strategic planning on reimbursement trends.

Requirements

• 7+ years of experience in managed care and/or government contracting in healthcare.
• Demonstrated experience in contract negotiation with payers.
• Strong knowledge of healthcare reimbursement methodologies, managed care contracting, and healthcare economics.
• Proven financial acumen to evaluate contract performance.
• Experience with Medicaid, Medicare, Medicare Advantage, and Commercial payers.
• Strong relationship management, communication, and negotiation skills.
• Bachelor’s degree required.

Nice to have

• Experience on both payer and provider sides of contracting.
• Background in behavioral health.
• Experience with value-based contracting, innovative pricing models, credentialing, or M&A activities.
• Established relationships with regional or national payers.
• Advanced degree (MBA, MHA).

Culture & Benefits

• Demonstrate belief that addiction is a brain disease, with hope, respect, and caring in interactions.
• Work independently under pressure, handling multiple tasks with good judgment on confidential issues.
• Equal opportunity employer committed to diversity and inclusion.
• Reasonable accommodations for disabilities.