Manager, Payer Contracting

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

📋 Description

• Assist in the negotiation, implementation, and oversight of payer contracts to ensure optimal reimbursement and adherence to compliance standards.

• Establish or renew contracts under new Tax Identification Numbers as required.

• Develop and maintain contract summary documents for all clients.

• Keep track of contract termination dates and facilitate renewals, renegotiations, or terminations as necessary.

• Manage contract terminations and uphold payer contracts and associated documents according to the company's filing protocols.

• Collect and analyze data to support negotiation strategies, improve rates, explore alternative payment models, and enhance revenue cycles.

• Aid in the preparation and assessment of payer contracts, amendments, and fee schedules.

• Act as the subject matter expert for the payer contract module in Athena.

• Upload and maintain fee schedules for both commercial and governmental payers.

• Develop and implement rule-based logic configurations.

• Track variance reporting to identify necessary rule revisions, emerging payer trends, and inappropriate payer practices such as underpayments.

• Monitor, interpret, and relay payer policy updates, coverage determinations, and regulatory modifications.

• Evaluate payer behavior prior to contract expiration and suggest revised rates to optimize client reimbursement.

• Generate reports and dashboards that summarize contract metrics and financial outcomes.

• Engage in client meetings as an expert on contract performance and opportunities for improvement.

• Inform client managers about impending renegotiation or termination periods.

• Cultivate relationships with payer Provider Representatives.

• Participate in team meetings to address payment terms, underpayments, and trends related to contracts.

• Collaborate with revenue cycle teams to resolve payment issues and assist with appeals or reconsiderations for underpaid or denied claims.

• Provide contract interpretation support to coding, billing, patient access, legal, compliance, operations, and clinical departments.

• Communicate contract updates and changes in reimbursement to relevant stakeholders.

• Facilitate the implementation of new payer programs, reimbursement models, and operational adjustments.

⛳️ Requirements

• Intermediate proficiency in Microsoft Outlook, Excel, PowerPoint, and Word.

• Skilled in Adobe applications.

• Strong written and verbal communication abilities.

• Experience with Laserfiche is preferred, though not mandatory.

• Understanding of healthcare payer contracting practices, including those related to commercial and government payers (Medicare, Medicaid, managed care).

• Familiarity with payer contract terms, fee schedules, amendments, notices, and termination clauses.

• Knowledge of payer policies, coverage determinations, and regulatory requirements impacting reimbursement.

• Proficiency in data analysis and financial reporting concerning contract performance and payer behavior.

• Experience within revenue cycle operations, including billing, coding, payment posting, underpayment analysis, clearinghouse functions, and appeals.

• Practical knowledge of practice management or EHR systems, preferably Athena IDX and payer contract modules.

• Familiarity with Payer Price or similar payer rate transparency tools.

• Demonstrated success in payer contracting negotiations.

• Capability to analyze, assess, and apply knowledge of market and healthcare trends to effectively communicate the value of contracts.

• A bachelor's degree in a relevant field such as healthcare administration or business is preferred.

• 3–5 years of experience in revenue cycle management, managed care, or a related financial role in healthcare.

• Over 2 years of experience in healthcare payer contracting.

• Willingness to travel within the United States and stay overnight when required.

• Anticipated travel of 10–15% of the time.

🏝️ Benefits

• Fully remote work setting.

• Opportunities for travel to client visits, conferences, and industry-related events.

• Participation in key industry conferences and networking opportunities.