Director of Payer Relations

at  Blue Balloon ABA

JOB SUMMARY

We are seeking a Director of Payer Relations for Blue Balloon ABA.
In this role, you will have responsibility to establish, nurture, and grow strategic relationships with payers, Medicaid agencies, and care management organizations. You will coordinate with some of our most important partners to provide updates on patient progress and outcomes, opening referral pathways, and working to resolve issues including (not limited to) authorizations, credentialling, and billing.
The ideal candidate combines deep ABA experience with understanding of payer dynamics and incentives, and excellent communication and stakeholder management skills.

QUALIFICATIONS

• 5+ years experience in ABA either in Payer Relations, Contracting, or Clinical Leadership capacity.
• Track record of leadership and innovation.
• Deep knowledge of outcomes data, payer incentives, and ABA processes and systems.
• Detail oriented, strong organizational, time management, analytical, problem-solving skills.
• Exceptional verbal, written, and interpersonal communication skills.
• Demonstrated commitment to cultivating a neurodiversity-affirming culture.
• A passion for working with children with Autism Spectrum Disorder and their families.

Ongoing payer relations:

• Schedule and lead regular update calls with priority payers and community partners, providing updates on kiddo progress, outcomes data, and other business developments.
• Understand payer priorities and needs; drive agenda, prepare appropriate materials and messaging, and ensuring the correct experts are on call to speak to payer questions.
• Build and maintain ongoing payer relationships and convey the value and impact of Blue Balloon ABA.
• Utilize relationships to help other departments and further business objectives—increasing referrals, accelerating authorizations, and addressing denials or billing timeliness.
• Facilitate and support payer visits to Blue Balloon sites as relevant.

Creative contracting and value based care

• Build on relationships to understand how to better align our model to the incentives and needs of payers.
• Provide insights to clinical leaders, contracting, and overall management to shape creative arrangements that better serve the needs of patients, payers, and Blue Balloon ABA.

Reporting excellence:

• Work closely with clinical and finance leaders to improve automation of reporting to ensure efficient workflows for regular payer updates.