Payer Strategy & Contracting Principal

This is a fully remote position, open to applicants in Arizona, +9 more states.

📋 Description

• Create and implement payer-specific and market-specific action plans that align with the enterprise payer strategy, growth objectives, and operational capabilities.

• Assess payer opportunities by analyzing referral trends, membership and enrollment data, reimbursement details, financial performance, market conditions, operational capacity, and strategic alignment.

• Examine payer and market performance to uncover growth opportunities, network deficiencies, underperforming contracts, renewal priorities, reimbursement possibilities, and risks of termination.

• Formulate recommendations for payer participation, contracting priorities, reimbursement strategies, and preferred provider opportunities.

• Lead the development, negotiation, renewal, and modification of agreements with national, regional, state, and local payers.

• Assess reimbursement methodologies and contract terms thoroughly.

• Create financial analyses, business cases, rate proposals, and evaluations of contract feasibility.

• Negotiate terms related to reimbursement, operations, administration, and other significant contract provisions.

• Oversee stakeholder reviews, secure leadership approvals, facilitate agreement execution, renewal planning, and monitor contractual milestones.

• Present contracting strategies, recommendations, risks, and business cases to leadership and governance bodies.

• Lead the cross-functional execution of new and revised payer agreements.

• Define implementation owners, deliverables, milestones, dependencies, and escalation processes.

• Develop workflows, communications, reporting structures, and processes for the implementation of payer agreements.

• Address payer-related issues involving referrals, authorizations, eligibility, denials, payments, reimbursements, and contract stipulations.

• Act as the primary business and contracting liaison for assigned payer relationships.

• Conduct regular payer business reviews focused on performance, operational challenges, growth, quality, and strategic objectives.

• Enhance network access, referral volume, preferred provider relationships, care coordination, quality initiatives, and value-based arrangements.

• Monitor payer and contract performance against negotiated terms, reimbursement expectations, volume projections, and financial metrics.

• Identify reimbursement leakage, negative trends, and operational performance factors.

• Collaborate with Finance, Revenue Cycle, Operations, and other stakeholders to develop corrective action plans.

• Evaluate the financial impact of reimbursement changes and alternative payment models.

• Provide leadership with reporting and recommendations on contract performance, financial risks, growth opportunities, renewals, and corrective measures.

• Foster collaboration across Operations, Sales, Finance, Revenue Cycle, Clinical, Legal, Compliance, Business Development, and other stakeholders.

• Prepare business cases, recommendations, and decision materials for contracting and payer governance discussions.

• Maintain contract documentation, decision records, action logs, implementation plans, and renewal timelines.

• Identify and raise financial, operational, contractual, compliance, and implementation risks.

• Serve as a subject matter expert on payer relationships and contracting strategies.

⛳️ Requirements

• Bachelor’s degree in Business, Healthcare Administration, Finance, or a related area, or equivalent relevant professional experience.

• A minimum of five years of experience in managed care, payer contracting, provider relations, payer account management, healthcare finance, business development, or healthcare operations.

• Proven experience in interpreting payer agreements and reimbursement structures, as well as leading contract negotiations.

• Strong financial acumen with the ability to assess reimbursement methodologies, contract economics, and business cases.

• Excellent analytical, negotiation, problem-solving, stakeholder management, and executive communication skills.

• Experience in home health, post-acute care, and/or managed care is preferred.

• Familiarity with episodic, fee-for-service, and value-based reimbursement models, authorization requirements, and revenue cycle processes is preferred.

• Experience in leading complex initiatives involving multiple functional and operational stakeholders is preferred.

• Ability to independently manage multiple payer priorities, deadlines, negotiations, and implementation activities is preferred.

• Experience with contract performance reporting, reimbursement analysis, and resolution of payer-provider issues is preferred.

• Experience in presenting contracting strategies, business cases, and recommendations to senior leadership is preferred.

• Minimum home internet speed of 25 Mbps download and 10 Mbps upload.

• A dedicated workspace free from ongoing interruptions to safeguard member PHI / HIPAA information.

🏝️ Benefits

• Bonus incentive plan based on company and/or individual performance.

• Medical benefits.

• Dental benefits.

• Vision benefits.

• 401(k) retirement savings plan.

• Paid time off.

• Company holidays.

• Personal holidays.

• Paid parental leave.

• Paid caregiver leave.

• Short-term disability.

• Long-term disability.

• Life insurance.

• Whole-person well-being and personal wellness support.

• Remote work arrangement.

• Occasional travel to Humana offices for training or meetings.