Manager of Managed Care Operations - Hybrid / Remote

Surgery Partners Careers•Nashville, TN

3d•Hybrid

About The Position

This role focuses on developing and executing payer negotiation and contracting strategies for assigned ambulatory surgery centers (ASCs) and physician groups. The Manager will lead contract negotiations, renewals, and amendments, partnering with facility and operational leadership to implement strategies and achieve reimbursement goals. The position involves analyzing contracts, collaborating with revenue cycle teams to resolve payer issues, monitoring contract performance, and maintaining relationships with payer representatives and internal stakeholders. The role also includes providing subject matter expertise on payer trends and supporting business development initiatives.

Requirements

Bachelors degree required in business, technology or healthcare related field
Minimum of 3 years of experience in managed care environment
2+ years of negotiation or provider relations experience between providers and major commercial payors in markets in the U.S. and/or experience in contract analysis for ASC services.
Experience with ASC reimbursement methodologies.
Experience working with payors and billing office staff to resolve payment discrepancies.
Reasonable understanding of healthcare CPT coding and billing.
Excellent quantitative and analytical skills, with attention to detail.
Moderate knowledge of Excel and/or ability to expand knowledge quickly.
Solid understanding of payer contract reimbursement methodologies and application of payor policies on reimbursement.
Strong writing skills and ability to communicate effectively in order to negotiate key terms of payor agreements.
Understanding of healthcare industry trends in payor negotiations including contract language, product development trends, pay for performance programs, bundled payment programs, etc.
Understanding of provider reimbursement methodologies from Medicare, and knowledge of how Medicare reimbursement is updated from time to time.
Must be self-motivated and able to work independently.
Inquisitive nature and interest in sharing knowledge among team members.
Must be able to provide timely written and verbal communication of complex negotiations to internal leadership.
Experience managing multiple projects and negotiations with varying teams and deadlines.
Strong communication skills necessary.
Team orientation toward success.

Nice To Haves

Experience working with clinically integrated networks, ACO’s, or other population health initiatives a plus.

Responsibilities

Develops and executes payer negotiation and contracting strategies for assigned ambulatory surgery centers (ASCs) and physician groups.
Leads and manages payer contract negotiations, renewals, amendments, and ongoing agreement administration.
Partners with facility, operational, and physician leadership to implement payer strategies and address contracting challenges.
Works to achieve facility-specific reimbursement and budget goals through effective negotiation and contract optimization.
Analyzes payer contracts, reimbursement methodologies, and financial models to support negotiations and identify revenue opportunities.
Collaborates with revenue cycle, business office, and analytics teams to investigate and resolve complex payer issues.
Monitors post-implementation contract performance to validate payer compliance and reimbursement accuracy.
Ensures timely and accurate implementation of negotiated contract terms and system updates.
Maintains strong working relationships with payer representatives, provider relations contacts, and internal stakeholders.
Communicates negotiation strategies, contract status, and reimbursement opportunities to internal leadership.
Provides subject matter expertise and education to internal teams regarding payer trends and reimbursement changes.
Supports business development and strategic growth initiatives by advising on market reimbursement trends and strategies.