Manager, Payer Contracting
About The Position
The Payer Contract Specialist supports the negotiation, implementation, and management of payer contracts to ensure optimal reimbursement and compliance. The role analyzes contract terms and reimbursement methodologies, monitors payer performance, and works with internal stakeholders to ensure payer agreements are accurately interpreted and executed. The position serves as the subject matter expert and owner of the payer contract module in Athena, maintaining client- and payer-specific fee schedules and rule-based logic. It monitors variance reports and payer behavior, identifies opportunities to improve reimbursement, and escalates issues such as underpayments. The role also monitors payer policies and regulatory changes, supports contract renewals and negotiations, prepares contract-performance reporting, and collaborates with clients, payers, and internal teams. This role covers the entire corporation and requires travel within the United States, including overnight trips. Travel is expected to be 10–15% of the time for client visits, conferences, and other industry-related events.
Requirements
- Intermediate skills in Microsoft Outlook, Excel, PowerPoint, and Word.
- Proficiency with Adobe.
- Effective written and verbal communication skills.
- Knowledge of healthcare payer contracting, including commercial and government payers such as Medicare, Medicaid, and managed care.
- Knowledge of payer contract terms, fee schedules, amendments, notices, and termination provisions.
- Knowledge of payer policies, coverage determinations, and regulatory requirements affecting reimbursement.
- Knowledge of data analysis and financial reporting related to contract performance and payer behavior.
- Experience with revenue-cycle operations, including billing, coding, payment posting, underpayment analysis, clearinghouse, and appeals.
- Working knowledge of practice-management or EHR systems; Athena IDX and payer contract modules are preferred.
- Familiarity or experience with Payer Price or a similar payer-rate transparency tool.
- A proven track record of successful payer-contracting negotiations.
- Ability to analyze, evaluate, and apply knowledge of market and healthcare trends to convey the value of a contract.
- Three to five years of experience in revenue-cycle management, managed care, or a related healthcare financial role.
- At least two years of experience in healthcare payer contracting.
Nice To Haves
- Experience with Laserfiche document storage.
- A bachelor's degree in a related field, such as healthcare administration or business.
- Working knowledge of Athena IDX or payer contract modules.
Responsibilities
- Establish or renew contracts under new Tax IDs as needed, in conjunction with the Chief Compliance Officer/General Counsel.
- Create and maintain contract summary forms for all clients.
- Monitor contract termination dates and coordinate renewals, renegotiations, or terminations in alignment with client directives.
- Process contract terminations and maintain contracts and related documents according to company file-storage protocols.
- Gather and analyze data to support negotiation strategies, rate improvements, alternate payment models, and revenue-cycle improvements.
- Assist with preparing and reviewing payer contracts, amendments, and fee schedules.
- Own the Athena payer contract module and maintain knowledge of client- and payer-specific configurations.
- Manage initial fee schedule uploads and ongoing maintenance for commercial and governmental payers, and create and configure rule-based logic.
- Monitor daily variance reports to identify needs for new or updated rules, flag emerging payer trends, and escalate inappropriate payer behavior, including underpayments, to leadership.
- Monitor, interpret, and communicate payer policy updates, coverage determinations, and regulatory changes to cross-functional teams in conjunction with the Chief Compliance Officer/General Counsel.
- Review payer behavior before contract expiration using analytical tools such as the Impact Analysis Report, and recommend revised rates to support negotiations and maximize client reimbursement.
- Prepare reports and dashboards summarizing contract metrics and financial outcomes as needed.
- Participate in monthly or quarterly client meetings as a subject matter expert, providing insight into contract performance, improvement opportunities, and recommended changes.
- Notify client managers of contracts approaching renegotiation or termination windows.
- Build and maintain positive relationships with payer Provider Representatives.
- Attend key industry conferences and networking events.
- Participate in team meetings addressing payment terms, underpayments, and emerging contract-related trends.
- Partner with revenue-cycle teams to resolve contract-related payment issues and assist with appeals or reconsiderations for underpaid or denied claims when necessary.
- Provide contract-interpretation guidance to internal departments, including coding, billing, and patient access.
- Work with legal, compliance, operations, and clinical departments during contract execution and renewals.
- Communicate contract updates and reimbursement changes to key stakeholders.
- Support implementation of new payer programs, reimbursement models, and operational changes.
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What This Job Offers
Job Type
Full-time
Career Level
Manager
