Director of Payor Strategy and Value

ACES HISTORY:

Founded30 years ago byACESChairwoman Kristin Farmer ACES has grown into a leading autism services platform serving 5000clients in90markets across 8 states supported bygrowth equity firm General Atlanticsince2020. With adifferentiatedclinical modelthat delivers twice the outcomes per hour of any other industry providerACES focus is to make step-change improvementsas the provider employer and partner of choiceto growwith excellencetowards our vision to be the best in ABA in America.

ROLE CONTEXT:

ACESis building apayor strategythat will definethe next 3-5yearsof growth. Our objective is to articulate our differentiated clinical and operational value secure the right contracts at the right rates for each payer expand value-based partnerships with national and regional health plans and execute a scalable payer go-to-market strategy that supports long-term growth.

ACESseeksahungry humble and collaborative leaderwho isequally comfortable developing strategy and rolling up their sleeves to execute individual will translate vision into action by building strong payer relationshipsdrivingcomplex negotiations identifying innovative reimbursement opportunities and partnering cross-functionally to deliver measurable results. Success in this role requires both strategic thinking and a scrappy entrepreneurial mindset with a relentless focus on creating long-term value for ACES our payer partners and the individuals we serve.

DETAILEDJOB SUMMARY:

TheDirector of Payor Strategy& Valuewillbe responsible for co-architectingand executingonACES enterprise payor strategy by leading national and state-level payor contracting negotiations and relationships; advancing value-based and alternative payment models; translating payor contracts into scalable compliant operational workflows; and partneringcross functionallywith finance operations growth and clinical leadership to drivethe bestclient outcomesclientgrowthmarket expansion andmarginexpansion.

RESPONSIBILITIES*:

Payor Strategy& Value:

• Co-architect and implement strategically valuable and economically sustainable payor strategies:

• Contracting roadmap for commercial payors Medicaid MCOs regional centers school districts

• Advance value-based and alternative payment models (P4P bundles outcomes-based arrangements) translating clinical quality and access metrics into defensible economic value

• Develop state-specific payor playbooks for priority and emerging marketswith Field/GrowthOps

• Execute on payor strategy action plans includingbuildingcross functional action plans that maintain or strengthen relationships with key payors

• Set andmanage to geography-specific payor-mix goals

• Manage payor negotiations end-to-end including rate setting contract structure escalators carve-outs and amendments

• Drive conversations with stakeholders for regular rate review and negotiation bringing in seniorexecutives to support when needed/additive

• Report-outs on performance opportunities and risk to executive team and key stakeholders

PayorRelations:

• Manageand create win-winpayor relationshipsserving as the primary interfacetopositionACESasthe best in ABAand adata-driven partner in early intervention and medically necessary ABA services

• Ensure high-level engagement leveraging ACES leaders tostrategically enhance relationships

• Represent and advocate for ACES ABA product

• Identify and mitigate payor-related risk including adverse policy changes utilization management friction denials and reimbursement erosionproactively escalating and resolving issues

Payor Margin Management:

• Partner with Data and Analytics team to forecast and evaluate the results of strategic options

• Analyze trends for business opportunities and market clinical/business changes

• Modelrate changes and forecastpayormix impacts andprofitability by payor;develop perspective on financial levers to pull through payor contracting hours impact mid-tiers overlaps VBC etc

*List of responsibilities is not meant to be exhaustive. ACES can modify this job description/responsibilities at any time and in its sole discretion.

ACES LEADERSHIPBEHAVIORS:The person in this rolemodelsACES values and Leadership Behaviors:

1. Solvefor We v. Me

1. ContinuouslyImprove

1. Actwith Accountability

1. Leadwith Purpose

1. ExpectExcellence

1. StayHumble and Empathetic

EXPERIENTIALCRITERIA:

• Direct experience negotiating and structuringalternative reimbursement models andvalue-based care agreements (shared savings risk corridors quality-based bonuses case rate/bundled models)

• Has built partnerships and problem solved with a growth mindset to drive growth (volume rate)

• Operated intersection of strategy and payor relations i.e. informed enterprise strategy (market entry M&A targets service line expansion) and executed it through contracts

• Translatedstrategy into cross-functional detailed action

• Obsession forwin-win value creation andtranslating ACES vision and purpose into growthto ensureACES andpayor return on investment

• Fluent intranslating company needsand clinical modelwith payors andvisaversa

• Creative thinkerproblem solver and dot connectertoenvision/capitalize onpayor/employer solutions

• Cross-functional collaborator; quickly builds trust and rapport

• High learning agility withnatural orientation to continuously improve results

• Ownermentalitywho can make progress without significant support or direction

QUALIFICATIONS:

• Bachelors orMastersdegreewith 6-10yearsexperiencein professional or multi-site healthcare businessinstrategicpayor rolestrongly preferred

• Alternative payment methodologies experience (e.g. pay for performance value-based care)highly preferredwith demonstrated track record/outcomes

• 3-5years demonstrated leadershipand cross-functionalexperience preferably withinapayorteam

• High level organizational skills with strong attention to detail

• Curiosity: Listeningandlearning mindset

• Distinguished interpersonal communication(oral written)and problem-solving skills

• Professional selling skills able to translate value of ACES clinical product/model to a Payor partner

• Metrics-Driven: Strong accountability with proven success in meeting timelines and deliverables

• Applied behavior analysis (ABA) experience and related licensure a plus

• Ability to travel as required

PHYSICAL REQUIREMENTS:

• Ability to exert up to 10 pounds of force and lift/move up to 15 pounds

• May include without limitationphysical demands:sitting typing screenviewing forextended periods