Manager, Payor Strategies

Main Line Health•Radnor, PA

4d•$101,858 - $157,810•Hybrid

About The Position

Healthcare is rapidly evolving, and strong payer partnerships are critical to ensuring patients have access to quality care while maintaining the financial strength needed to invest in our communities. As the Manager, Payor Strategies, you will play a key role in shaping Main Line Health's relationships with insurance providers, negotiating contracts that support our mission, optimize reimbursement, and position the organization for success in an increasingly complex healthcare landscape. Working at the intersection of strategy, finance, revenue cycle, and operations, you'll influence decisions that impact millions of dollars in reimbursement, support innovative value-based care initiatives, and help ensure Main Line Health can continue delivering exceptional care to the patients and communities we serve.

Requirements

Bachelor's degree in Healthcare Administration, Business Administration, Finance, Economics, Public Health, or a related field.
Minimum of five (5) years of experience in payer contracting, provider contracting, managed care, medical economics, healthcare informatics, or related healthcare strategy functions.
Experience working within a health system, hospital, healthcare organization, managed care organization, or insurance payer environment.
Strong contract negotiation and relationship management skills.
Demonstrated analytical, financial modeling, and problem-solving abilities.
Advanced Microsoft Excel proficiency and strong working knowledge of Microsoft Office applications.
Exceptional communication, presentation, and stakeholder management skills.
Ability to independently manage multiple priorities in a fast-paced environment while maintaining strong attention to detail.

Nice To Haves

Master's degree in Business Administration (MBA), Healthcare Administration (MHA), Finance, or a related field.
Experience with value-based reimbursement models, population health strategies, or alternative payment arrangements.
Knowledge of Accountable Care Organizations (ACOs), Clinically Integrated Networks (CINs), and evolving healthcare reimbursement models.
Experience conducting reimbursement analyses, fee schedule reviews, and contract modeling.
Prior experience leading complex negotiations involving healthcare payers, providers, or managed care organizations.

Responsibilities

Lead negotiations, implementation, and ongoing management of payer agreements across Main Line Health's acute care, physician, rehabilitation, and ancillary service lines.
Serve as the primary relationship manager for assigned insurance providers, fostering strong partnerships and resolving operational and contractual challenges.
Analyze reimbursement methodologies, fee schedules, contract performance, and compensation structures to identify opportunities for optimization.
Support the development of innovative payer-provider arrangements, including value-based payment models and alternative reimbursement strategies.
Monitor contract performance and collaborate with operational leaders to improve outcomes related to revenue cycle operations, patient access, utilization management, and reimbursement.
Provide expertise and guidance regarding payer contract language, compensation terms, and reimbursement methodologies.
Facilitate meetings with payer representatives and internal stakeholders to strengthen performance, address challenges, and improve partnership outcomes.
Stay informed on regulatory, legislative, and market changes impacting managed care, accountable care organizations (ACOs), clinically integrated networks (CINs), and healthcare reimbursement.