Manager, Payer Contracting

📋 Description

• Acquisition, coordination, and analysis of payer contracts.

• Secure and maintain group-level contracts 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 and beneficial for the organization.

• Collaborate with the Payer Enrollment and RCM teams to ensure contracts are correctly identified, negotiated, implemented, and reviewed promptly.

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

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

• Maintain up-to-date knowledge of Medicare reimbursement methodologies, State Medicaid (including MCOs) payment methodologies, and Commercial (including commercial MA plans) payment methodologies.

• Coordinate fee schedule development with our RevOps team using financial models and analysis in negotiating rates with payers.

• Oversee and manage all group-level payer contracts.

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

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

• Build and maintain productive professional relationships with Payer Contract representatives.

• Resolve escalated issues related to specific payer contracts.

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

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

• Manage special projects and fulfill other duties as required.

⛳️ Requirements

• Bachelor’s Degree.

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

• In-depth understanding of payer contract reimbursement and analytic modeling.

• Experience in value-based contracting.

• Proven ability to manage multiple tasks concurrently while supporting team members with routine daily activities.

• Familiarity with current policies and guidelines that influence contracts, pricing, rebates, legislative regulations, etc., in the managed care sector.

• 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 like 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.