New York, New York 10036
The Payer Strategy and Contracting department manages the payer relationships and agreements of the organizations CareAbout supports, including fee-for-service agreements, value-based and shared savings programs, Medicare Advantage arrangements, and Medicare accountable care organization participation, together with the strategic planning, contract performance tracking and reconciliation work that follows from those agreements.A
Payer Relations and Outreach- Serve as the department's primary working contact with payer provider relations, network management, contracting, and value-based care representatives on routine matters.
- Initiate, document, and follow through on outreach to payers regarding contract questions, roster and participation issues, claims and rate discrepancies, data and report requests, program deliverables, and open items from prior meetings.
- Maintain the department's payer contact directory, including escalation contacts for each payer and program.
- Draft correspondence, meeting requests, and follow-up communications for Senior Vice President review, and send communications on the department's behalf as directed.
- Track each open payer item in a departmental log with owner, status, next step, and target date, and report status weekly.
Joint Operating Committee and Meeting Management- Own the JOC calendar across all payer relationships: schedule meetings, confirm internal and payer attendees, distribute agendas and pre-read materials, and manage rescheduling.
- Collect agenda inputs and supporting data from clinical operations, care coordination, quality, risk adjustment and coding, revenue cycle management, and finance ahead of each meeting.
- Take minutes, record decisions and action items, distribute them after each meeting, and track action items to completion.
- Maintain a consolidated action item log across all payers.
- Support internal governance and committee meetings with scheduling, materials, minutes, and recordkeeping as assigned.
Cross-Functional Coordination- Act as the department's liaison to clinical operations, care coordination, quality, risk adjustment and coding, revenue cycle management, credentialing, and finance.
- Field questions from internal teams on contract terms, program requirements, attribution rules, payer policies, and payment mechanics. Research answers in the executed agreements and program documents, respond directly on settled matters, and escalate to the Senior Vice President where a question requires interpretation or a decision.
- Maintain a log of questions received and answers provided so that responses are consistent and reusable.
- Coordinate provider roster and participation submissions to payers and reconcile payer rosters against internal records.
Contract and Program Administration- Maintain the contract inventory for each supported organization: executed agreements, amendments, fee schedules, program exhibits, and key terms including effective dates, term and renewal provisions, notice windows, rate escalators, and reporting requirements.
- Maintain the calendar of contractual deliverables and deadlines, including quality and data submissions, roster updates, reconciliation timelines, and notice dates, and confirm that each deliverable is completed on time.
- Support contract implementation by confirming with revenue cycle management that negotiated rates and terms are loaded correctly, and by confirming with credentialing and the payer that participation and rosters are accurate.
- Monitor payer policy updates, fee schedule notices, and program communications, and summarize the operational and financial implications for the Senior Vice President.
Analysis and Reporting- Prepare and maintain contract performance tracking for value-based and shared savings programs, including attribution, quality performance, incentive and shared savings payments, and reconciliation status.
- Prepare fee schedule comparisons, rate positioning analyses relative to Medicare, and claims and payment variance analyses in support of fee-for-service negotiations and rate integrity reviews.
- Build and maintain trackers, workbooks, and dashboards in Excel and the organization's business intelligence tools.
- Prepare data pulls, reports, and supporting documentation for negotiations, committee meetings, and executive reviews.
- Verify figures, sources, and labels before any analysis is distributed.
Special Projects- Carry assigned departmental initiatives from assignment through completion, including acquisition and affiliation diligence support, new program and contract implementations, network development and optimization for the independent practice association, accountable care organization participation activities, and process improvement projects.
- Draft memos, summaries, presentations, and status updates for executive, committee, and physician audiences.
- Manage multiple concurrent assignments with changing priorities and maintain a current project list with status and next steps.
- Perform other duties as assigned.
QualificationsRequired- Bachelor's degree in healthcare administration, business administration, public health, economics, finance, or a related field.
- Two to four years of experience at a health plan, medical group, independent practice association, accountable care organization, management services organization, health system, or healthcare consulting firm in a contracting, provider relations, network management, value-based care, revenue cycle, or healthcare analytics role.
- Working knowledge of provider reimbursement, including fee-for-service fee schedules and their relationship to the Medicare Physician Fee Schedule, CPT and HCPCS coding basics, and claims adjudication.
- Familiarity with value-based payment arrangements such as shared savings, pay-for-performance, and Medicare Advantage quality and risk adjustment programs.
- Proficiency in Microsoft Excel, including lookups, pivot tables, and work with large data sets, and in Microsoft Word, PowerPoint, and Outlook.
- Clear, accurate, and concise written communication, demonstrated in professional correspondence, meeting minutes, and summaries.
- Demonstrated organization and follow-through, including the ability to manage a high volume of open items across many counterparties without losing track of any of them.
- Professional presence in interactions with external payer representatives, physicians, and executives.
- Discretion in handling confidential contract, financial, and protected health information, and familiarity with HIPAA requirements.
Preferred- Master's degree (MHA, MPH, or MBA)
- Familiarity with the New Jersey and Florida payer landscape
- Experience with the Medicare Shared Savings Program, Medicare Advantage value-based arrangements, or commercial pay-for-performance programs.
- Experience reading and summarizing contract language, including fee schedules, amendments, and program exhibits.
- Experience supporting joint operating committees or other payer-provider governance meetings.
- Experience with SQL, Power Query, Power BI, Domo, Snowflake, or Python for reporting and analysis.
- Experience with athenahealth or another practice management system
- Residence in New Jersey or Florida with the ability to travel within both states as required.
Physical Requirements- Sitting at the desk most of the day.
- Standing or walking less than two hours per day.
- Lifting no more than ten pounds on rare occasions.
- Must be able to work at a computer and attend virtual meetings on a regular basis.
Salary within our ranges may also be determined by your education, experience, knowledge, skills, abilities, and location, as required by the role, as well as internal equity and alignment with market data.
Featured Benefits:- Health, dental, and vision insurance.
- 401K with automatic employer contribution.
- PTO and Paid Holidays.
- Company paid Life Insurance.
- Access to voluntary short and long-term disability insurance.
- Access to additional life insurance.
- Access to a variety of Wellness programs.
Compensation is based on the level and requirements of the role.
Salary within our ranges may also be determined by your education, experience, knowledge, skills, abilities, and location, as required by the role, as well as internal equity and alignment with market data.
