Payer Strategy & Contracting Principal

The Provider Contracting Principal is responsible for developing and executing on the payer strategy, leading contract negotiations, managing payer relationships, and driving operational implementation and financial performance for an assigned market/payer portfolio.

This role connects enterprise priorities related to payer mix, growth, network access, reimbursement, and economic sustainability with regional and market leadership and key cross-functional partners, including Sales, Operations, Finance, Revenue Cycle, Clinical, Legal, and Compliance.

The Principal ensures payer agreements are strategically aligned, financially viable, operationally executable, and well-positioned to deliver measurable value.

The Principal independently leads assigned payer initiatives and negotiations within delegated authority and established governance and approval processes and serves as a key business partner to market and enterprise leadership.

The Payer Strategy and Contracting team leads the development, negotiation, implementation, and ongoing management of profitable national, regional, state and local payer relationships across episodic, fee-for-service, and value-based reimbursement models.

In partnership with Business Development and other enterprise stakeholders, the team evaluates and supports preferred provider and contracted business opportunities across the acute and post-acute continuum, including Medicare Advantage, Commercial, and other value-based payment models.

The Provider Contracting Principal translates enterprise payer strategy into market-level execution. The role evaluates payer opportunities, develops contracting strategies, negotiates agreements, leads cross-functional implementation, manages payer relationships, monitors contract performance, and identifies opportunities to improve reimbursement, access, volume, and financial outcomes.

• Develop and execute payer-specific and market-specific action plans aligned with enterprise payer strategy, growth priorities, and operational capacity.
• Evaluate payer opportunities using referral trends, membership and enrollment data, reimbursement, financial performance, market dynamics, operational capacity, and strategic fit.
• Analyze current payer and market performance to identify growth opportunities, network gaps, underperforming agreements, renewal priorities, reimbursement opportunities, and potential termination risks.
• Develop recommendations regarding payer participation, contracting priorities, reimbursement strategies and preferred provider opportunities.
• Partner with operational, sales, clinical, and market leadership to establish strategic objectives before negotiations and operational implementation.

• Lead the development, negotiation, renewal, and amendment of assigned national, regional, state and local payer agreements within delegated authority and established governance requirements.
• Evaluate reimbursement methodologies and contract terms to determine appropriate financial and operational structures.
• Partner with Finance and Operations to develop financial analyses, business cases, rate recommendations, and contract feasibility assessments.
• Negotiate reimbursement, operational, administrative, and other material contract provisions in collaboration with Legal, Compliance, Finance, Revenue Cycle, Clinical and operational stakeholders.
• Coordinate stakeholder review, leadership approvals, agreement execution, renewal planning, and key contractual milestones.
• Present contracting strategies, recommendations, risks and business cases to leadership and governance forums as appropriate.

• Translate contractual requirements into clear operational expectations for referral intake, authorizations, clinical operations, billing, reimbursement and revenue cycle.
• Lead cross-functional implementation of new and amended payer agreements, establishing accountable owners, deliverables, milestones, dependencies and escalation pathways.
• Partner with operational and functional leaders to develop workflows, communications, reporting, and other processes required for successful implementation.
• Identify and coordinate resolution of payer-related issues involving referrals, authorizations, eligibility, denials, payment, reimbursement or other contract requirements.
• Lead or support time-sensitive payer initiatives and escalations that may materially affect patient access,…