Contracts Manager

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

📋 Description

• The Contracts Manager is tasked with supervising payer contract management activities within the Revenue Cycle Management (RCM) department for a home health and durable medical equipment (DME) organization.

• This position acts as the subject matter expert on payer reimbursement terms, contract interpretation, fee schedules, and operational requirements that affect billing and collections.

• The Contracts Manager collaborates closely with payers, revenue cycle leadership, compliance, credentialing, billing operations, and IT/system teams to ensure that payer contract terms and reimbursement requirements are accurately translated into operational workflows and system configurations.

• This role also oversees a Contracts Specialist who is in charge of entering payer pricing, fee schedules, and contractual requirements into company systems and electronic networks (ENS).

• Review, analyze, and maintain payer contracts related to home health and DME services.

• Interpret reimbursement methodologies, fee schedules, billing rules, authorization requirements, and compliance obligations specific to each payer.

• Identify the operational implications of payer contract terms and communicate these requirements to the relevant departments.

• Monitor contract performance and reimbursement trends to detect discrepancies, underpayments, or opportunities for revenue recovery.

• Collaborate with leadership on contract renewals, amendments, and payer negotiations by offering operational and financial insights.

• Maintain a centralized repository for payer contracts and associated documentation.

• Establish and document payer requirements for implementation within company systems, ENS platforms, and billing workflows.

• Ensure that payer-specific pricing, billing edits, authorization rules, and reimbursement requirements are accurately configured and maintained.

• Work with IT, billing, and operational teams to validate system setups and resolve configuration issues that affect claims or reimbursement.

• Oversee testing and validation processes for updates from payers, changes in fee schedules, and system enhancements.

• Supervise and support the Contracts Specialist responsible for entering pricing and contractual requirements into company systems.

• Review and approve fee schedule uploads and payer configuration updates to ensure accuracy and completeness.

• Provide training, guidance, and performance management for direct reports.

• Develop and maintain standard operating procedures related to payer contract implementation and maintenance.

• Ensure compliance with federal, state, and payer regulations in implementing payer contract requirements.

• Serve as a resource for billing, collections, intake, and operational teams regarding contract interpretation and payer requirements.

• Assist with audits, appeals, and reimbursement investigations pertaining to payer contract terms.

• Support continuous improvement initiatives aimed at enhancing reimbursement accuracy and undertake all other related duties as assigned.

⛳️ Requirements

• Bachelor’s degree in Healthcare Administration, Business, Finance, or a related field is preferred.

• A minimum of 5 years of experience in healthcare revenue cycle, managed care contracting, payer relations, or DME/home health reimbursement is required.

• Strong understanding of reimbursement methodologies, billing requirements, and revenue cycle operations for home health and DME.

• Experience in interpreting managed care contracts and converting contract terms into operational requirements is essential.

• Previous experience in managing or supervising staff is preferred.

• Knowledge of Medicare, Medicaid, commercial insurance, and managed care payer structures is necessary.

• Familiarity with healthcare billing systems, fee schedule management, and payer configuration processes is required.

• Strong analytical, organizational, and problem-solving skills are essential.

• Excellent communication skills and the ability to collaborate across functions are required.

• Comprehensive knowledge of the managed care industry and product administration/implementation is expected.

🏝️ Benefits

• Medical, Vision, Dental, Short- and Long-term insurance

• 6+ Days of Holidays Pay

• 17 days of PTO

• Employer paid life insurance

• 401K with employer contribution

• Wellness program with reward incentives

• Employee recognition and reward programs

• Comprehensive paid training program