Job Description

POSITION SUMMARY:

The Payer Contract Manager responsible for the negotiation and maintenance of all healthcare contracts. The position leads the entire contract process from pre-contract through post-signature phases, and closely collaborates with the sales team and internal departments to ensure staff are informed of new contracts, changes to existing contracts and updates to the medical and billing policies of the payers we serve.

ESSENTIAL DUTIES & RESPONSIBILITIES:

• Develop, negotiate, and maintain contracts with all payers, e.g., insurance companies, MSOs, IPAs, TPAs and government programs;
• Actively participate in establishing strategic business goals with the Leadership Team;
• Assure contractual arrangements meet financial targets and legal/regulatory compliance requirements. There will be an emphasis on analyzing cost and utilization data;
• Facilitate the approval process of all contract documents from pre-contract through post signature phases;
• Responsible for the accuracy of supporting documentation for contracts and completing documents accurately;
• Develop and maintain processes that provide timely notification of critical contract events (e.g., renewals, termination and due dates contained within the agreements);
• Ensure contractual language is kept current; evaluate fee schedule on a yearly basis to identify possible opportunities for additional covered services, medical policy changes and reimbursement;
• Works with operational staff to develop action plans necessary to accomplish organizational goals;
• Coordinate and communicate contractual terms to the billing department; ensure staff is informed of changes in medical policy & billing policies;
• Conduct on-going assessments of assigned networks and make recommendations for strategic initiatives, goals, and objectives;
• Develop and maintain periodic, e.g., bi-weekly, reports on the status of all contracts;
• Assure accurate data entry of contract specifications and terms into database and completeness of all contracting processes;
• Assists the Revenue Cycle Leadership team and CFO with other payer issues as directed;
• Maintain excellent written and verbal communication with all internal and external customers;
• Assist with all contracting administration and projects, as needed.

EDUCATION, QUALIFICATIONS & EXPERIENCE:

• Minimum of 3 years of relevant experience with hospital, clinic, physician, and/or primary care and health system contracting;
• Bachelor’s Degree or equivalent experience;
• Strong demonstrated knowledge and understanding of revenue cycle, healthcare industry, legal and regulatory requirements;
• Willingness to actively participate “hands-on” in all aspects of the contract administrative process.

SKILLS & CHARACTERISTICS

• Exceptional and proven provider partnership skills and interpersonal skills;
• Excellent contract negotiation skills;
• Ability to develop and deliver presentations to internal and external groups;
• Results driven, persistent - able to self-direct and work independently showing initiative, while seeking guidance when appropriate;
• Ability to multi-task and be flexible in a fast paced and growing organization;
• Detail-orientated;
• Strong organizational and analytical skills;
• Demonstrated strength in computer software, e.g., MS Office Suite, PowerPoint, social media, and internet-based research.

DESIRED CERTIFICATIONS:

• None

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