Contract Management – Revenue Integrity Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee all negotiations for new payer contracts, managing the entire process from initial outreach to execution, ensuring that terms are in line with organizational objectives and market standards.

• Develop and uphold fee schedules and contracted rates for professional services, drug/pharmacy, and ancillary services. Take ownership of rate-setting decisions in collaboration with Finance and clinical leadership.

• Update and audit all payer allowable tables within Athena and any other relevant systems. Coordinate the extraction of allowable schedules on a quarterly or monthly basis according to payer requirements and internal scheduling needs.

• Identify, monitor, and address payment discrepancies arising from mismatched allowable amounts between contracted rates and actual payer remittances. Collaborate with billing and RCM teams to rectify discrepancies and prevent future occurrences.

• Act as the main contact for payer inquiries and projects concerning contract pricing. Ensure timely resolution of issues initiated by payers and proactively communicate risks to leadership.

• Produce and disseminate regular reports on contract performance, allowable schedules, out-of-network activities, and no-go statuses. Ensure that leadership has the necessary visibility for strategic decision-making.

• Perform out-of-network analyses to assess financial exposure and guide contracting strategies. Maintain and circulate no-go reports to highlight payers or services where participation is not financially sustainable.

• Oversee all updates within Athena related to contracts, allowable updates, payer configurations, and rate changes. Ensure that system accuracy is consistently maintained, with changes tested and validated upon implementation.

⛳️ Requirements

• Associate’s degree in healthcare administration, business, finance, or a related field; or equivalent relevant experience in payer contracting or revenue integrity.

• A minimum of 3–5 years of experience in payer contracting, allowable management, or revenue integrity roles.

• Strong comprehension of fee schedule structures, payer reimbursement methodologies, and contract terms across professional, drug/pharmacy, and ancillary service lines.

• Proven experience in managing allowable tables and rate configurations within Athena EHR or similar practice management systems.

• Proficient in identifying and addressing payment variances and mismatched allowables.

• Experience with out-of-network analyses and no-go reporting frameworks.

• Excellent analytical and problem-solving abilities with a keen attention to detail.

• Strong communication and negotiation skills; comfortable engaging directly with payer representatives.

• Capability to manage multiple priorities and deadlines in a dynamic, growth-focused environment.

• Experience in a multi-specialty, multi-location healthcare organization is preferred.

• Athena EHR experience is strongly preferred; familiarity with MSO structures is a plus.

🏝️ Benefits

• Health insurance

• Flexible work arrangements