Senior Contracting Specialist

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

📋 Description

• Lead negotiations on contracts for clients with payers across various fee-for-service and value-based models.

• Create negotiation materials that encompass rate benchmarking, reimbursement trend analysis, and summaries of financial impacts.

• Identify opportunities for rate optimization and suggest contract frameworks that enhance rates.

• Analyze and interpret contract language from payers, medical groups/IPAs, and hospitals/ancillary contexts.

• Ensure precise documentation of payer contracts, amendments, fee schedules, and logs of client communications.

• Act as a subject-matter expert and informal mentor to Contracting Specialists.

• Collaborate with Revenue Cycle, AR, and Billing teams to implement contract terms into systems and workflows.

• Assist in converting clinical program details into reimbursable contract terminology.

• Identify and report discrepancies between contracted terms and actual performance from payers.

• Aid in preparing contract terms for review by clients and legal advisors.

• Coordinate with Legal, Finance, Service Delivery, and Client Success on matters related to contracts.

• Provide the Manager with updates regarding contract status, risks, and negotiation advancements.

• Ensure readiness for audits and compliance with payer standards.

• Serve as the primary client-facing contact for assigned accounts and address escalated issues.

• Cultivate relationships with payer contacts and represent the organization in meetings and operational reviews.

• Engage in client meetings and calls to aid in strategic initiatives.

• Monitor trends in payer reimbursement, policy updates, and competitive dynamics.

• Evaluate payer performance, denial patterns, and payment discrepancies.

• Assist in the development of payer scorecards and key performance indicators (KPIs).

• Contribute to financial modeling for contracting, re-contracting, and decisions regarding entry into new markets.

⛳️ Requirements

• Over 5 years of experience in managed care/payer contracting, either from the payer perspective (health plan contracting or network management) or the provider perspective (medical group, IPA, hospital, or ancillary provider contracting).

• Proven experience in negotiating payer agreements and interpreting contract language.

• Solid understanding of reimbursement methodologies, including FFS, RBRVS, capitation, and value-based models.

• Bachelor's degree in Healthcare Administration, Business, Finance, or a related field, or equivalent experience.

• Capacity to function under pressure and handle multiple negotiations simultaneously with a strong sense of urgency.

• Demonstrated experience in a client-facing role, effectively managing and resolving escalated client issues.

• Proficiency in Excel, contract management systems (e.g., Ironclad or similar platforms), and project management tools.

• Working proficiency with company-approved AI tools (Claude, Microsoft Copilot) to enhance contract analysis, drafting, and workflow efficiency.

• Strong written and verbal communication skills, capable of representing the organization effectively in discussions with payers.

• Exceptional attention to detail in contract review, interpretation, and documentation.

🏝️ Benefits

• Ventra performance-based incentive plan.

• Discretionary incentive bonus in line with company policies.

• Referral bonus.