Director of Payer Contracting

A multi-site healthcare provider organization in Texas is seeking a Director of Payer Contracting to lead enterprise-wide payer strategy and contracting efforts. This role will oversee all commercial, Medicare Advantage, Medicaid Managed Care, and direct-to-employer agreements, partnering closely with executive leadership to align contracting with financial, operational, and growth priorities.

This is a highly visible position responsible for driving reimbursement strategy, leading complex negotiations, and advancing value-based care initiatives across the organization.

Key Responsibilities

Strategic Leadership

• Develop and execute enterprise payer strategy aligned with growth, quality, and financial performance objectives
• Advise executive leadership on reimbursement trends, policy changes, and market dynamics
• Partner cross-functionally with finance, legal, revenue cycle, and clinical leadership

Payer Contracting & Negotiations

• Lead negotiation and management of payer agreements across commercial, Medicare Advantage, Medicaid Managed Care, and employer-direct contracts
• Structure value-based arrangements including bundled payments, shared savings, and risk-based models
• Partner with legal and compliance on contract terms and regulatory requirements
• Establish processes for payer disputes, denials, and escalations

Financial & Performance Management

• Partner with finance to build payer performance reporting, forecasting, and reimbursement models
• Analyze payer mix, contract yield, and revenue performance to identify optimization opportunities
• Support pricing strategy aligned to cost structure and service line objectives

Value-Based Care

• Align payer contracts with population health and care management initiatives
• Oversee performance across risk-based arrangements, including quality and financial metrics

Stakeholder Management

• Serve as executive point of contact for payer relationships
• Represent the organization in external payer discussions and industry forums
• Present regularly to executive leadership on payer strategy and performance

Qualifications

• 10+ years of experience in payer contracting, reimbursement, or managed care strategy within a healthcare provider or payer setting
• Demonstrated success leading complex negotiations and implementing value-based contracts
• Strong understanding of reimbursement methodologies (DRG, APC, per diem, capitation)
• Strong financial and analytical skillset with experience in contract modeling and performance analysis
• Prior leadership experience managing teams and cross-functional initiatives
• Bachelor's required; MBA, MHA, or MPH preferred

Additional Details

• Executive-level visibility with regular interaction across senior leadership
• Opportunity to lead payer strategy in a dynamic reimbursement environment
• Focus on value-based care and long-term payer partnerships