Head of Payer Relationships Strategy

About the role

This role is responsible for defining and executing the payer strategy for Marvin Behavioral Health. The hire will own the end to end management of external payer relationships, ensuring clinical and financial alignment across the organization. They will serve as the definitive expert on contract performance, reimbursement mechanics, and regulatory compliance for payers. This position requires a strategic thinker who is comfortable balancing long term planning with the immediate resolution of billing and enrollment roadblocks. The individual will translate complex payer rules into actionable steps for clinical and revenue teams. They will ensure that provider workflows remain efficient and that financial outcomes are protected. This role operates at the intersection of clinical operations, finance, and compliance. Success in this position will be measured by the stability and growth of the payer portfolio.

Key facts

What you'll do

• Manage the full lifecycle of payer contracts, including negotiations, renewals, and performance monitoring.
• Analyze and update fee schedules within AdvancedMD to ensure reimbursement accuracy and identify underpayment trends.
• Oversee provider credentialing and enrollment, ensuring all documentation is current and billing gaps are prevented.
• Serve as the primary point of contact for payers to resolve complex disputes, wrongful denials, and escalated appeals.
• Partner with Finance to align chargemaster strategy and fee schedules with the cost of care.
• Lead revenue readiness for new partner or plan launches by coordinating contracts, system configurations, and billing requirements.
• Collaborate with the RCM Manager to monitor KPIs and provide strategic guidance on denial trends and revenue performance.
• Report on contract outcomes and revenue risks to executive leadership.
• Develop and maintain documentation for payer policies, procedures, and exceptions to ensure operational consistency.
• Evaluate new payer opportunities and conduct due diligence on coverage, rates, and network adequacy before onboarding.
• Implement process improvements to streamline credentialing cycles and reduce time to reimbursement.
• Coordinate cross functional initiatives to resolve systemic billing issues impacting multiple payers.
• Monitor regulatory changes impacting behavioral health reimbursement and adjust strategies accordingly.
• Facilitate training for clinical and administrative staff on payer specific requirements and compliance standards.

Requirements

• Bachelor's degree in Healthcare Administration, Finance, Business, or a related field.
• Minimum of 7 years of progressive experience in revenue cycle management.
• At least 3 years of experience in a leadership capacity.
• Hands on expertise in behavioral health payer contracting and fee schedule management.
• Proven success in negotiating payer contracts and improving reimbursement rates.
• Direct experience managing provider credentialing and payer enrollment processes.
• Proficiency with EHR/practice management software, specifically AdvancedMD.
• Strong knowledge of CPT, HCPCS, and ICD-10 coding within behavioral health.
• Experience managing the billing setup and credentialing requirements for new partner launches.
• Demonstrated ability to work effectively in a hybrid environment with intermittent in office collaboration.
• Understanding of payer compliance and audit requirements relevant to behavioral health services.
• Strong analytical skills to interpret financial data and contract terms.
• Excellent written and verbal communication skills for stakeholder interactions.
• Commitment to maintaining the highest standards of confidentiality and data security.

Nice to have

• Master's degree (MBA or MHA).
• Professional certifications such as CRCR, CHFP, or CPAM.
• Experience in multi state telehealth or virtual first behavioral health settings.
• Familiarity with denial analytics platforms and RCM automation tools.
• Background in scaling payer relations functions within a startup or high growth environment.

Practical notes

• This is a hybrid role requiring 1-2 days per week in the office.
• Compensation range is $110,000 to $150,000 annually, supplemented by equity participation.
• The position reports to the leadership team and collaborates closely with Finance, Clinical Operations, and Revenue Cycle Management.
• All applicants must meet the specified experience and technical requirements without exception.
• The role requires frequent interaction with payer representatives, necessitating professional presence and reliability.
• Candidates should be prepared to demonstrate a track record of improving revenue performance through strategic payer management.
• On site presence is required for key planning sessions, contract reviews, and cross functional initiatives.
• The successful candidate will be expected to mentor team members on best practices for credentialing and reimbursement.
• This role involves significant responsibility for mitigating revenue risk through proactive contract and denial management.
• Proficiency with AdvancedMD is non negotiable for this position.
• The candidate must be able to manage multiple priorities in a fast paced behavioral health environment.
• Relocation is not required but may be considered for the selected candidate.
• Performance in this role will be evaluated based on contract execution, revenue outcomes, and stakeholder satisfaction.
• The position is integral to the growth and sustainability of the payer network within the organization.