Manager, Payer Relations, Contracting, Credentialing

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

📋 Description

• Act as the main operational relationship manager for designated health plans and payer partners.

• Cultivate and sustain strategic relationships with payer representatives, network leaders, contracting teams, and other key stakeholders.

• Create a structured engagement schedule for high-impact payer relationships.

• Recognize and escalate payer issues that impact patient access, reimbursement, authorization, claims payment, or operational performance.

• Collaborate with Revenue Cycle Management and Utilization Review leadership to resolve payer issues.

• Keep track of payer and market trends for financial, operational, and access opportunities or risks.

• Assist in developing payer strategies for new markets, new facilities, acquisitions, new service lines, and geographical expansion.

• Maintain a pipeline for payer opportunities and escalations.

• Deliver executive-level reports on payer relationships, negotiations, network development, reimbursement opportunities, and significant risks.

• Formulate payer negotiation strategies in conjunction with the EVP of Revenue Cycle Management and Finance.

• Create scalable multi-state licensing and credentialing processes.

• Assess reimbursement performance and identify contracts or rates that need renegotiation.

• Keep summaries of payer contracts that include reimbursement terms, authorization requirements, timely filing provisions, appeals, exclusions, and termination provisions.

• Measure the financial impact of proposed rate changes and contract amendments using RCM analytics.

• Identify chances to enhance network participation and improve patient access.

• Ensure the operationalization of negotiated contract terms across Admissions, Utilization Review, Clinical Operations, Billing, and other departments.

• Oversee the entire lifecycle of contract management, negotiations, rate increases, HCPCS/CPT requirements, and professional services.

• Handle in-network and out-of-network contracting and negotiations for the organization and employed providers.

• Coordinate credentialing and recredentialing applications with clinical operations, licensing agencies, insurance carriers, and other entities.

• Maintain databases for licensing, contracting, and credentialing while developing related processes and procedures.

• Monitor requirements from entities, accrediting organizations, payers, and both state and federal regulations, implementing necessary adjustments.

• Analyze reimbursement by payer, authorization barriers, contractual adjustments, overpayments, underpayments, out-of-network exposure, network adequacy, rate performance, contract compliance, and patient access obstacles.

• Execute other duties as assigned.

⛳️ Requirements

• Bachelor’s degree in business administration, health management, or equivalent experience is required.

• A minimum of five (5) years of experience in managed care contracting and provider credentialing.

• At least three (3) years of experience in hospital and/or payer negotiation and analysis.

• Familiarity with fee-for-service and/or fee-for-value reimbursement methods, delegated credentialing workflows, and a working knowledge of all major payers.

• Strong capability to synthesize information, extract insights and next steps, diagnose issues, identify trends, and craft targeted solutions.

• Self-motivated individual who can organize processes, enhance existing workflows, and seek efficiency.

• Exceptional attention to detail and the ability to spot opportunities in data or workflows while thoroughly documenting processes.

• Capacity to work under pressure and juggle multiple priorities while maintaining meticulous attention to detail.

• Proficient in Microsoft Office Suite.

• Knowledge of behavioral health care HCPCS/CPT coding is preferred.

• Strong business acumen and financial skills are preferred.

• Ability to maintain confidentiality of sensitive information is preferred.

• Excellent verbal and written communication skills are preferred.

• Strong interpersonal and relationship-building abilities are preferred.

• Capability to perform multiple tasks concurrently is preferred.

• Ability to prioritize workload in a fast-paced environment is preferred.

• Employees with potential access to protected health information must adhere to HIPAA procedures and guidelines.

🏝️ Benefits

• Subsidized Health Insurance Coverage for Employee, Spouse, & Dependent(s).

• 100% Employer Paid Basic Life Insurance equal to 1x annual salary, up to $100,000.

• 100% Employer Paid Employee Assistance Program.

• Voluntary Dental, Vision, Short-Term Disability, Supplemental Life & AD&D, Critical Illness, Accident, and Hospital Indemnity Insurance.

• Pre-tax Savings Accounts for all IRS-allowable medical and dependent care expenses.

• Generous Paid Time Off plan.

• Employee Referral Bonuses.

• 401K Retirement Plan & Employer Match.