5+ years of experience in managed care or payer contracting on either payer or provider side
Proven track record in negotiating payer agreements and interpreting contract language
Strong understanding of reimbursement methodologies including FFS, RBRVS, capitation, and value-based arrangements
Bachelor's degree in Healthcare Administration, Business, Finance, or related field, or equivalent experience
Experience mentoring or guiding junior contracting staff is preferred
Responsibilities
Conduct contract negotiations with payers for FFS and value-based models
Develop negotiation materials such as rate benchmarking and financial impact summaries
Identify and recommend contract structures for rate optimization
Review and interpret payer contract language across various contexts
Maintain accurate documentation of contracts and client communications
Act as a liaison between Payer Strategy & Contracting and internal stakeholders
Serve as a client-facing contact for resolving escalated concerns regarding payer contracts
Benefits
Opportunity to work in a senior individual contributor role
Engagement with both payer and provider sides of contracting
Access to advanced contract management and AI tools
Collaborative environment with cross-functional teams
Potential for professional development through mentoring opportunities
Full Job Description
Job Summary
We are seeking a Senior Contracting Specialist to join our Payer Strategy & Contracting team, reporting to the Manager, Payor Strategy & Contracting. This is a senior individual contributor role for a candidate with hands-on payer contracting experience - gained either on the payer side (health plan network management or contracting) or the provider side (medical group, IPA, hospital, or ancillary provider contracting). The Senior Contracting Specialist independently manages contract negotiation, analysis, and documentation for an assigned portfolio of provider clients and facilities on behalf of our clients, operating with a sense of urgency and comfort under pressure. This is a client-facing role responsible for resolving escalated client concerns related to payer contracts and reimbursement, while also serving as a resource to Contracting Specialists on the team.
Essential Functions and Tasks
Payer Strategy & Negotiation
Conduct contract negotiation discussions on behalf of clients with payers across fee-for-service (FFS) and value-based contract models, escalating high-complexity or high-value negotiations to the Manager as needed
Develop negotiation materials including rate benchmarking, reimbursement trend analysis, and financial impact summaries
Identify rate optimization opportunities within the assigned book of business and recommend contract structures that support improved rates
Review and interpret payer contract language across payer, medical group/IPA, and hospital/ancillary contexts
Apply working knowledge of managed care frameworks, reimbursement methodologies, and applicable healthcare regulations to contract review and negotiation
Maintain accurate, up-to-date documentation of payer contracts, amendments, fee schedules, and client communication logs
Serve as a subject-matter resource and informal mentor to Contracting Specialists on contract interpretation and negotiation best practices
Deal Execution & Financial Alignment
Partner with Revenue Cycle, AR, and Billing teams to ensure contract terms are accurately operationalized within systems and workflows
Support translation of clinical program details - including virtual care, hospital-based professional services, and multi-site models - into reimbursable contract terms
Identify and escalate discrepancies between contracted terms and actual payer performance
Assist in preparing contract terms for client and client's legal counsel for review
Cross-Functional Collaboration
Act as a key liaison between Payer Strategy & Contracting and internal stakeholders - including Legal, Finance, Service Delivery, and Client Success - on contract-related matters
Provide clear, timely updates to the Manager on contract status, risks, and negotiation progress
Support audit readiness and compliance with payer requirements, including documentation and contract interpretation guidance
Client & Payer Relationship Management
Serve as a client-facing point of contact for assigned accounts, fielding and resolving escalated client concerns related to payer contracts, reimbursement, and payer performance
Maintain working relationships with assigned payer contacts and represent the organization in routine payer meetings and operational reviews
Participate in client meetings or calls to support strategic initiatives and provide status updates on contracting activity
Track payer reimbursement trends, policy changes, and competitive dynamics relevant to the assigned book of business
Escalate emerging payer or client risks and opportunities to the Manager
Analytics & Performance Monitoring
Analyze payer performance, denial trends, and payment variances within the assigned portfolio to identify and act on improvement opportunities
Support development of payer scorecards and KPIs to evaluate contract effectiveness
Contribute to financial models supporting contracting, re-contracting, and new market entry decisions
Education and Experience Requirements
Required
5+ years of experience in managed care/payer contracting, gained on either the payer side (health plan contracting or network management) or the provider side (medical group, IPA, hospital, or ancillary provider contracting)
Demonstrated experience negotiating payer agreements and interpreting contract language
Working knowledge of reimbursement methodologies, including FFS, RBRVS, capitation, and value-based arrangements
Bachelor's degree in Healthcare Administration, Business, Finance, or a related field, or equivalent experience
Preferred
Experience on both the payer and provider sides of contracting
Familiarity with Medicaid, Medicare Advantage, and/or pediatric reimbursement structures
Experience mentoring or guiding junior contracting staff
Experience collaborating with offshore or distributed team members
AAHAM and/or HFMA certification
Knowledge, Skills, and Abilities
Required
Ability to operate under pressure and manage multiple concurrent negotiations with a strong sense of urgency
Demonstrated experience operating in a client-facing capacity, with the ability to professionally manage and resolve escalated client concerns
Proficiency with Excel, contract management systems (e.g., Ironclad or comparable platforms), and project management tools
Working proficiency with company-approved AI tools (Claude, Microsoft Copilot) to support contract analysis, drafting, and workflow efficiency
Strong written and verbal communication skills, with the ability to represent the organization credibly in payer-facing conversations
High attention to detail in contract review, interpretation, and documentation
Compensation
Base Compensation will be based on various factors unique to each candidate including geographic location, skill set, experience, qualifications, and other job-related reasons.
This position is also eligible for a discretionary incentive bonus in accordance with company policies.
