The Payer Contracting and Relations Manager serves as the primary liaison between the organization and payer representatives, addressing operational issues, resolving disputes, and maintaining positive ongoing relationships. This role is also responsible for developing, negotiating, and managing contracts with third party payers to ensure optimal reimbursement rates and strong strategic partnerships.
Position will work out of our Atwater Admin office, with possibility to work Hybrid once acclimated to the duties of the role.
Schedule is Monday - Friday, 8:00am - 5:00pm
Compensation: $85,924 - $94,516 Annual Salary
Duties and Responsibilities - Lead the end to end contract negotiation process with all payers, including Medicare, Medi-Cal and Managed Care plans.
- Ensure all contracts comply with state, federal and healthcare regulations.
- Manage the "signature to implementation" process, ensuring all contracts are properly executed, updated in the billing system as applicable, and communicate to the appropriate departments.
- Identify opportunities for network expansion and evaluate the feasibility of new "at-risk" or bundled payment models.
- Stay abreast of industry trends, legislative changes, and competitor pricing to maintain a competitive edge.
- Maintain a comprehensive payer contracts, terms, and renewal timelines.
- Manage and strengthen the relationship with payers and act as the primary liaison between the organization and payer representatives to foster strong, collaborative relationships.
- Work with health plans to resolve systemic issues or credentialing bottlenecks.
- Resolve escalated payer issues, including claims disputes, denials, and operational concerns.
- Manage payer credentialing and enrollment processes.
- Analyze contract terms, reimbursement rates, and financial performance to optimize revenue and reduce risk.
- Collaborate with executive leadership to develop payer strategies that align with organizational goals and identify opportunities for improvement.
- Track payer trends, policy changes, and regulatory updates and communicate these impacts across the organization.
- Collaborate with internal teams to ensure contract alignment, adherence to payer requirements, and operational efficiency.
- Participate in audits, appeals, and escalations related to payer issues as needed.
- Prepare reports and present contract performance metrics to leadership.
- Track key performance indicators (KPIs) related to payer performance and reimbursement.
- Other projects or duties as assigned.
Physical Demands - Lift up to 25 pounds occasionally and push up to 50 pounds (on wheels) on rare occasions.
- Must be able to hear on the phone and those who are served in-person, and speak clearly in order to communicate information to clients and staff.
- Must have vision with or without lenses that is adequate to read memos, a computer screen, forms and administrative documents.
Work Environment The physical environment requires the employee to work indoors, primarily in an office setting. The noise level inside is quiet to average. Use of general office equipment is required on a daily basis. Travel may be required at times.
Education/Experience Requirements Minimum Qualifications: - Demonstrated experience negotiating contracts and managing payer relationships
- Strong knowledge of various reimbursement methodologies
- Knowledge of healthcare regulations and compliance requirements
- Strong understanding of government programs such as Medicare and Medi-Cal
- Experience with population health initiatives
- Proficiency in healthcare analytics and reporting
- Ability to communicate clearly and concisely both orally and in writing
- Ability to interpret contracts and financial data and translating data into actionable summaries for internal stakeholders
- Proficiency in Excel and other Microsoft tools
- Strong problem-solving and conflict resolution abilities
- Ability to manage multiple contracts and deadlines simultaneously
Education/Experience: - High school diploma or equivalent.
- Bachelor's degree in Healthcare Administration, Finance, Business Administration, or a related field, or five (5) years of relative experience in lieu of degree.
- Three (3) years of progressive experience in payer contracting, provider relations or healthcare finance.
- Federally Qualified Health Center (FQHC) experience preferred.
