Manager, Healthcare Contracts

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

📋 Description

• Develop, negotiate, and oversee contracts with various payer types, such as insurance companies, MSOs, IPAs, TPAs, and government programs.

• Conduct research on territories to pinpoint gaps in payer coverage and facilitate expansion into new markets.

• Ensure all contractual agreements align with financial objectives and adhere to legal and regulatory standards.

• Analyze cost, utilization, and reimbursement data to inform negotiation strategies and decision-making processes.

• Lead the comprehensive contract process from pre-contract planning through to post-signature implementation.

• Manage internal approval workflows for all contract documents.

• Guarantee the accuracy and completeness of all supporting documentation.

• Create and maintain systems to monitor critical contract milestones, including renewals, terminations, and significant deadlines.

• Cultivate strong relationships with contracted providers and payer partners.

• Review and revise contractual language to ensure it remains accurate and relevant.

• Assess fee schedules annually to uncover opportunities for expanded services, reimbursement adjustments, and policy updates.

• Collaborate closely with leadership to support strategic business objectives and organizational growth initiatives.

• Communicate contract terms, updates, and policy changes to internal departments, particularly billing and revenue cycle teams.

• Keep staff informed about payer medical policy changes, billing requirements, and reimbursement updates.

• Perform ongoing evaluations of assigned networks and suggest strategic initiatives.

• Prepare bi-weekly status reports on all contracts and contracting activities.

• Ensure precise data entry of contract terms and specifications into internal databases.

• Provide support for contracting administration and special projects as required.

⛳️ Requirements

• A minimum of 3 years of experience in healthcare contracting with hospitals, clinics, physician groups, primary care networks, or health systems.

• Bachelor’s degree is mandatory.

• Strong understanding of healthcare industry operations, payer structures, and regulatory requirements.

• Proven skills in contract negotiation and experience managing payer relationships.

• Exceptional written and verbal communication skills.

• Ability to work autonomously, take initiative, and manage multiple priorities in a dynamic environment.

• Strong organizational, analytical, and problem-solving capabilities.

• Proficiency with MS Office Suite, PowerPoint, and internet-based research tools.

• Experience with Epic software is essential.

• Background in working for a medical insurance company, MSO, IPA, or TPA.

• Demonstrated capacity to develop and deliver presentations to both internal and external stakeholders.

• Strong interpersonal skills with a proven track record of establishing effective provider partnerships.

🏝️ Benefits

• Health insurance

• Retirement plans

• Paid time off

• Flexible work arrangements