Manager, Payer Contracting

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

📋 Description

• Promote and oversee all managed care contracting initiatives for the hospital and clinics.

• Responsible for assisting with all payer contracts.

• Negotiate, implement, and sustain all payer agreements along with their respective policies.

• Stay informed about all managed care market activities and adapt strategies as necessary.

• Accountable for the negotiation, execution, and performance tracking of all managed care contracts for the health system.

• Review and analyze contract language, including reimbursement methodologies and fee structures.

• Maintain a centralized contract repository and ensure proper version control.

• Ensure contracts adhere to federal and state regulations and collaborate with internal and external legal teams to review terms to mitigate risks.

• Act as the primary liaison between the organization and payer representatives.

• Assist operational teams with contract interpretation and issue resolution.

• Identify and negotiate supplemental payments.

• Monitor key contract metrics, including payer mix, expiration/renewal dates, and reimbursement rates.

• Lead and nurture collaborative relationships with payers and employers.

⛳️ Requirements

• A Bachelor's degree is mandatory.

• A minimum of three (3) years of experience in managed care contracting is required.

• Familiarity with Epic is essential.

• Experience with contract management software is necessary.

• Understanding of California and federal regulations related to managed care contracting, billing, and compliance.

• Knowledge of population health and total cost of care is preferred.

• Proficient in Microsoft Office applications, including Excel, PowerPoint, and Word.

• Exceptional skills in engaging with the public, patients, and colleagues through positive written and verbal communication.

🏝️ Benefits

• None