The Director of Payor Relations is responsible for developing, managing, and strengthening relationships with commercial and government payors to support the organization's Applied Behavior Analysis (ABA) services. This role focuses on optimizing reimbursement, improving contract performance, and ensuring long-term payor partnership through data-driven storytelling, outcomes reporting, and strategic rate negotiations.
This position plays a critical role in ongoing payor engagement, retention, and financial performance improvement.
Office Location: El Segundo, CA
Pay Range: $115,000 - $130,000 DOE + Bonus Plan
Key Responsibilities: Payor Relationship Management - Serve as the primary point of contact for assigned payors, maintaining strong, proactive relationships
- Conduct regular business reviews and check-ins with payor representatives
- Identify risks to payor relationships and develop mitigation strategies
- Partner with internal teams (clinical, revenue cycle, operations) to ensure alignment with payor expectations
- Document and update CRM with payor contacts and activity weekly
- Review and update provider portals and directories
Payor Performance & Outcomes Reporting - Develop and deliver compelling, data-driven presentations demonstrating clinical outcomes, quality metrics, and value of ABA services
- Translate clinical and operational data into clear narratives tailored to payor priorities (e.g., cost savings, member outcomes, access)
- Lead quarterly or semi-annual business reviews with payors
- Continuously refine reporting frameworks to strengthen the organization's value proposition
Rate Strategy & Negotiation - Identify opportunities for rate increases based on performance, market benchmarks, and outcomes
- Prepare and present rate increase proposals supported by data and financial modeling
- Lead negotiations with payors to improve reimbursement rates and terms
- Track and analyze reimbursement trends to inform negotiation strategy
Contract Retention & Growth - Drive retention of existing payor agreements through proactive engagement and demonstrated value
- Support expansion of services within existing payor relationships (e.g., new markets, service lines)
- Monitor contract performance and escalate issues impacting retention
Cross-Functional Collaboration - Collaborate with Revenue Cycle to address denial trends, underpayments, and operational friction points
- Partner with Clinical Leadership to align on outcomes reporting and quality metrics
- Work with Finance to evaluate financial impact of rate changes and payor mix
Market Intelligence - Monitor industry trends in ABA reimbursement, payor policies, and competitive positioning
- Provide insights to leadership on payor strategy and risks/opportunities
Key Performance Indicators (KPIs) - Number of payor presentations delivered (monthly/quarterly)
- Number of rate increase requests submitted
- Average reimbursement rate improvement (%)
- Payor contract retention rate (%)
- Success rate of rate negotiations
- Growth in revenue tied to rate improvements or strengthened payor relationships
- Payor satisfaction / relationship health (qualitative + survey-based)
Qualifications Required - Bachelor's degree in Healthcare Administration, Business, Finance, or related field
- 5-10 years of experience in payor relations, managed care, or healthcare contracting (ABA or behavioral health strongly preferred)
- Demonstrated experience with rate negotiations and payor-facing presentations
- Strong analytical skills with ability to interpret and present clinical and financial data
- Deep understanding of reimbursement in ABA and/or behavioral health
Preferred - Experience in multi-state ABA provider organizations
- Familiarity with Medicaid and commercial payor dynamics in autism services
- Advanced degree (MBA, BHA)
Skill & Competencies - Executive-level communication and presentation skills
- Negotiation and influencing skills
- Data storytelling and visualization
- Strategic thinking with strong business acumen
- Relationship management and stakeholder engagement
- Problem-solving and cross-functional collaboration
