Payer Contracts Manager

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

📋 Description

• Oversee the entire lifecycle of contracts with payers, IPAs, and medical groups, which includes initial assessments, negotiations, execution, implementation, renewals, amendments, and terminations.

• Build and sustain relationships with California IPAs, medical groups, health plans, and other payer collaborators.

• Assess reimbursement rates, fee schedules, contract language, and financial terms.

• Negotiate reimbursement and contractual terms with commercial health plans, Medicare Advantage plans, Medicaid managed care organizations, IPAs, and delegated medical groups.

• Review and interpret California IPA agreements related to delegated risk, financial responsibilities, authorization requirements, claims submissions, reimbursements, and dispute resolutions.

• Create contract analyses, reimbursement comparisons, and financial models.

• Coordinate contract implementation with Revenue Cycle, Finance, Operations, Credentialing, and other internal stakeholders.

• Convert contract requirements into workflows, system configurations, and operational guidance.

• Maintain a centralized repository for contracts, amendments, fee schedules, renewal dates, notice requirements, and essential provisions.

• Monitor contract performance and investigate reimbursement discrepancies.

• Assist in resolving issues related to underpayments, denials, authorizations, eligibility, claims routing, reimbursements, and contract interpretations.

• Keep abreast of trends in California managed care and payer sectors.

• Support contracting efforts for new markets, service lines, and the opening of infusion centers.

• Develop scalable contracting processes, tools, and reporting practices.

⛳️ Requirements

• A Bachelor’s degree in healthcare administration, business, finance, or a related field is required.

• An advanced degree is preferred.

• A minimum of five years of experience in managed care contracting, payer relations, network development, reimbursement, or a similar healthcare role.

• Direct experience in negotiating and managing contracts with California IPAs and delegated medical groups is essential.

• Established knowledge of the California managed care landscape and common IPA contracting structures.

• A strong understanding of delegated arrangements, financial responsibilities, risk-based and fee-for-service reimbursements, authorization requirements, claims processes, and dispute-resolution provisions.

• Experience in negotiating and administering agreements with both commercial and government-sponsored health plans.

• A solid understanding of healthcare reimbursement methodologies, fee schedules, contract structures, and managed care terminology.

• Strong project-management capabilities and the ability to handle multiple contracts, deadlines, and competing priorities.

• Experience in infusion therapy, specialty pharmacy, ambulatory healthcare, or another specialty provider setting is strongly preferred.

• Experience in supporting payer contracting across multiple states is preferred.

🏝️ Benefits

• Opportunities for professional growth.

• A flexible work environment.

• Minimal travel required throughout California.