Director of Payer Relations

1 мес. назад

110k–150k USD / yearUSADirectorRemote

Senior leader responsible for driving payer strategy, contract performance, fee schedule management, and provider credentialing for Marvin Behavioral Health.

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Master's degree (MBA, MHA, or related)
CRCR, 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

Другое

The Director of Payer Relations is a senior leader responsible for driving Marvin's payer strategy, contract performance, fee schedule management, and provider credentialing function. This role serves as the primary owner of all payer relationships and is the internal expert on how Marvin gets paid. While the Director provides strategic oversight of the broader revenue cycle operation and partners closely with the RCM Manager, their core focus is external: negotiating contracts, managing fee schedules, resolving complex payer issues, and ensuring every provider is credentialed and enrolled before a single claim is submitted.
This is a player-coach role. The Director sets strategy and builds systems, but also personally engages payers when it matters most — picking up the phone on a wrongful denial, leading a contract renegotiation, or stepping in on a credentialing escalation. The ideal candidate is a seasoned RCM professional who has deep payer contracting expertise and takes pride in both strategic thinking and hands-on execution. This is a hybrid role with an expectation of 1-2 days per week in our LA , NYC or Denver Office, the remainder of the days remote work.
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
Ensure compliance with payer policies, mental health parity laws, and applicable state and federal billing regulations
Serve as the primary point of contact for all payer representatives; maintain direct, active relationships and know who to call to get things done
Personally 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
Own fee schedule management end-to-end: negotiation, loading, maintenance, and reconciliation
Ensure fee schedules are correctly loaded in AdvancedMD for every payer and updated promptly when contracts change
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
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
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
Lead system configuration in AdvancedMD for new payers and partners: fee schedule loading, payer enrollment linkage, and claim routing
Build and maintain a launch readiness checklist and timeline; flag risks early and drive cross-functional accountability to close gaps
Serve as the RCM subject matter expert in partner implementation conversations, translating payer and billing requirements into plain language for operational and clinical stakeholders
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
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
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
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
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