Manager, Payer Contracting

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

📋 Description

• Acquisition, coordination, and assessment of payer contracts.

• Secure and uphold group-level agreements with payers, including delegated payer contracts where feasible, leveraging OpenLoop’s NCQA Accreditation.

• Negotiate fee schedules for both new and existing contracts in a manner that is efficient, effective, and advantageous for the organization.

• Collaborate with the Payer Enrollment and RCM teams to ensure contracts are properly identified, negotiated, implemented, and reviewed in a timely fashion.

• Work together with other functional areas within the organization to ensure that payer contracts are structured to positively impact the company.

• Review contract terms and conditions to facilitate the accurate implementation of contracts.

• Stay updated on Medicare reimbursement methodologies, State Medicaid (including MCO’s) payment methodologies, and Commercial (including commercial MA plans) payment methodologies.

• Coordinate the development of fee schedules with our RevOps team, utilizing financial models and analyses to negotiate rates with payers.

• Manage and oversee all group-level payer contracts.

• Act as a liaison internally among Billing/Coding, Finance, Information Technology, and Clinical Operations regarding updates and changes to group payer contracts.

• Monitor contract renewals and renegotiate contracts as necessary upon renewal.

• Establish and maintain productive professional relationships with payer contract representatives.

• Resolve escalated issues pertaining to specific payer contracts.

• Assist in analyzing the payer mix and rate structure of payer contracts.

• Maintain a working knowledge of the billing database for reporting purposes.

• Manage special projects and perform other duties as required.

⛳️ Requirements

• Bachelor’s Degree.

• 4+ years of prior experience in managed care contracting within a provider or payer setting.

• Comprehensive understanding of payer contract reimbursement and analytic modeling.

• Experience in value-based contracting.

• Ability to manage multiple tasks simultaneously while supporting team members in their routine daily activities.

• Familiarity with current policies and guidelines impacting contracts, pricing, rebates, legislative regulations, etc., in the managed care environment.

• Knowledge of provider contracting, financial arrangements, and fee schedules, along with an understanding of healthcare reimbursement methodologies and guidelines is preferred.

• Understanding of claims processing systems and guidelines.

• Proficient in computer data entry, GSuite, payer portal navigation, and provider data management systems such as MDStaff, Medallion, or Verisys, with experience in ticketing platforms such as Jira, ZenDesk, or Zoho Desk.

• Ability to adapt to and navigate business-related software.

• Capability to meet sensitive deadlines and organize workload with minimal supervision.

🏝️ Benefits

• Medical, Dental, and Vision plans.

• Flexible Spending/Health Savings Accounts.

• Flexible PTO.

• 401(k) with Company Match.

• Life Insurance, Pet Insurance, and more.