The posting
Job Summary:
We are seeking a highly experienced Payor Contracting Specialist to lead and support all aspects of health plan contracting for our growing healthcare organization. This role is primarily responsible for managing payer relationships, negotiating and maintaining provider contracts, conducting reimbursement analysis, and ensuring successful participation in insurance networks.
The ideal candidate has a strong background in commercial, Medicare, Medicaid, and managed care contracting, with proven experience navigating reimbursement structures, performing fee schedule analyses, and leading contract negotiations. While credentialing knowledge is a plus, the primary focus of this position is healthcare payer contracting, reimbursement optimization, and network development to support the organization's rapid growth and expansion.
Key Responsibilities:
- Manage the full lifecycle of payer contracting, including negotiation, implementation, renewal, and termination of contracts with health plans and insurance carriers.
- Establish and maintain strong relationships with payers, managed care organizations, and provider networks.
- Negotiate reimbursement rates, contract terms, and payment arrangements to optimize organizational performance.
- Conduct detailed fee schedule analyses, including code-by-code comparisons of payer reimbursement rates against provider and group charges.
- Analyze reimbursement methodologies and identify underpaid or undervalued services across payer contracts.
- Develop rate negotiation strategies and prepare supporting financial and utilization data to strengthen contract negotiations and counteroffers.
- Review and analyze payer agreements, amendments, fee schedules, and contract language for accuracy, compliance, and financial impact.
- Track contract expirations, renewals, and renegotiation opportunities.
- Research and resolve contract-related issues, discrepancies, reimbursement concerns, and payer disputes.
- Collaborate with leadership, revenue cycle, credentialing, and operations teams to support organizational growth initiatives and maximize reimbursement opportunities.
- Monitor industry trends, payer policies, fee schedule changes, and reimbursement updates that may impact contracts and provider revenue.
- Maintain accurate contract documentation, reimbursement models, and reporting.
- Assist with provider enrollment and credentialing activities as needed.
Qualifications:
- Minimum of 3 years of experience in healthcare payer contracting, managed care contracting, or provider network contracting.
- Strong understanding of commercial, Medicare, Medicaid, and managed care health plans.
- Experience negotiating payer contracts, reimbursement rates, and payment arrangements.
- Demonstrated experience performing fee schedule analysis and reimbursement modeling.
- Knowledge of healthcare reimbursement methodologies, contract management processes, and payer fee schedules.
- Strong analytical skills with the ability to evaluate reimbursement data and identify revenue optimization opportunities.
- Excellent negotiation, communication, and relationship management skills.
- Ability to manage multiple contracts and priorities in a fast-paced environment.
- Advanced proficiency in Microsoft Excel and Microsoft Office applications.
Preferred Skills
- Experience with provider credentialing and enrollment processes.
- Experience supporting multi-specialty medical groups, healthcare organizations, or physician practices.
- Bachelor's degree in Healthcare Administration, Business Administration, Finance, or a related field.
- Familiarity with healthcare compliance and regulatory requirements.
