Job DescriptionThe
Executive Director of Payer Relationships serves as Elwyn's senior leader responsible for developing, managing, and expanding strategic relationships with commercial, government, and value-based payers across all operating states. This executive partners closely with organizational leadership to strengthen Elwyn's payer network, negotiate favorable reimbursement agreements, identify new contracting opportunities, and position Elwyn for long-term growth.
This position combines executive relationship management, strategic contracting, reimbursement negotiation, and market expansion while overseeing the operational execution of payer agreements through the organization's contract management processes.
The Executive Director serves as the organization's primary liaison with health plans and accountable care organizations, ensuring payer strategies align with Elwyn's strategic growth priorities
ESSENTIAL DUTIES AND RESPONSIBILITIES- Strategic & Payor Development
- Develop and execute Elwyn's enterprise payer strategy across all markets.
- Identify opportunities to establish relationships with new commercial, Medicaid Managed Care, Medicare
Advantage, Behavioral Health Organizations, Accountable Care Organizations (ACOs), and other strategic payer partners.- Cultivate executive-level relationships with payer leadership.
- In collaboration with the VP Marketing & Growth, COO, and Service Line Leadership, represent Elwyn during executive payer meetings, negotiations, and strategic planning discussions.
- Identify emerging reimbursement opportunities that support organizational growth.
- Contract Negotiation & Network Strategy
- Lead negotiations for new payer agreements and contract renewals.
- Negotiate reimbursement rates, value-based payment arrangements, performance incentives, and contract language.
- Analyze reimbursement methodologies and financial impact of proposed agreements.
- Collaborate with Finance, Revenue Cycle, Legal, Program Operations, and Compliance throughout negotiations.
- Recommend contracting strategies that improve revenue while expanding market access.
- Maintain awareness of state and national payer trends impacting behavioral health and intellectual/developmental disability services.
- Relationship Management
- Serve as the executive relationship owner for Elwyn's largest payer partners.
- Conduct regular executive business reviews with health plans.
- Resolve high-level payer issues affecting reimbursement, authorization, referrals, or operational performance.
- Partner with Business Development and Operations to strengthen referral pipelines from payer organizations.
- Develop collaborative initiatives that improve member outcomes and payer satisfaction.
- Contract Administration Oversight
- Provide leadership and oversight of the Contracting Coordinator responsible for contract administration.
- Ensure all contracts are routed, reviewed, approved, and executed through IntelAgree in accordance with organizational policies.
- Monitor contract lifecycle management including renewals, amendments, expirations, and compliance.
- Establish standardized contracting workflows across the organization.
- Maintain contract repository integrity and reporting.
- Credentialing, Provider Enrollment, and Insurance Paneling
- Provide executive oversight of organizational credentialing, provider enrollment, recredentialing, and insurance paneling activities.
- Ensure eligible practitioners, programs, facilities, and organizational entities are enrolled with appropriate government and commercial payers.
- Oversee processes involving CAQH, Medicare enrollment, Medicaid enrollment, commercial insurance
applications, delegated credentialing, roster management, and payer revalidation requirements.- Establish standards and performance expectations for timely provider enrollment and panel participation.
- Monitor enrollment status, application aging, payer response times, expiring credentials, recredentialing deadlines, and outstanding documentation.
- Ensure credentialing and enrollment activities support organizational compliance, billing readiness, and timely claims submission.
- Collaborate with Human Resources, Medical Staff Leadership, Compliance, Revenue Cycle, and Operations to obtain and maintain required provider information.
- Develop escalation processes for delayed enrollment, payer denials, closed panels, roster discrepancies, and other barriers to reimbursement.
- Ensure credentialing and paneling priorities align with program openings, service expansions, acquisitions, and new contract implementation.
- Market Intelligence
- Monitor payer market dynamics and competitive reimbursement trends.
- Evaluate opportunities for participation in innovative payment models including:
- Value-Based Care, Risk-Based Contracts, Alternative Payment Models, Behavioral Health Integration, Specialty Networks
- Provide executive leadership with recommendations regarding payer opportunities and threats.
- Cross-Functional Leadership
- Partner closely with the following internal teams to ensure successful implementation of payer agreements: Finance, Revenue Cycle, Operations, Clinical Leadership, Legal, Compliance, Marketing & Business
- Development, Credentialing
- Leadership Responsibilities
- Supervise Contracting staff.
- Establish departmental goals and performance metrics.
- Develop payer relationship management standards.
- Create executive dashboards tracking:
- Contract status, Network participation, Reimbursement improvements, Contract cycle times, Payer performance, Revenue opportunities
- Perform other duties as assigned
QUALIFICATIONS- Bachelor's degree in Healthcare Administration, Business Administration, Public Health, or related field required.
- Master's degree (MBA, MHA, MPH, or related) preferred.
Minimum 10 years of progressively responsible healthcare leadership experience.- Minimum 5 years leading payer contracting and negotiations.
- Demonstrated success negotiating complex commercial and government payer agreements.
- Experience with behavioral health reimbursement preferred.
- Strong executive presentation and relationship-building skills.
- Experience supervising professional staff.
- Experience in multi-state healthcare organizations.
- Knowledge of Medicaid Managed Care, Medicare Advantage, commercial insurance, and behavioral health funding.
- Experience with value-based reimbursement models.
- Experience with contract lifecycle management software such as IntelAgree.
