Payer Negotiation Specialist
About The Position
The Single Case Agreement (SCA) Specialist is responsible for securing reimbursement and coverage for services, therapies, or medical technologies on a patient-by-patient basis through negotiation with health plans. This role serves as a key liaison between providers, payers, patients, and internal teams to ensure timely access to care when standard coverage pathways are not available. About RomTech ROMTech® is a groundbreaking telemedicine technology with remote clinical oversight and fully customizable therapy protocols. The PortableConnect® (the device) enables gentle, therapeutic movement within a comfortable range of motion. Light, easy, and frequent sessions make it easier for the body to heal and recover. The result: patients recover and return to their activities of daily living more quickly, with less pain and drugs, and with better mobility.
Requirements
- 3–7+ years of experience in healthcare reimbursement, payer relations, managed care contracting, or revenue cycle
- Proven experience negotiating with health plans (SCAs, LOAs, or out-of-network agreements preferred)
- Strong understanding of prior authorization, medical necessity, and appeals processes
- Knowledge of commercial insurance, Medicare, and Medicaid structures
- Strong negotiation and influencing skills
- Ability to communicate clinical and financial value effectively
- Detail-oriented with strong organizational and case management abilities
- Comfortable working in fast-paced, high-stakes patient access environments
- Excellent written and verbal communication skills
Nice To Haves
- Experience working with specialty therapies, medical devices, or high-cost procedures
- Familiarity with CPT/HCPCS coding and reimbursement methodologies
- Prior interaction with payer medical directors or utilization management team
Responsibilities
- Initiate and lead negotiations with commercial and government health plans to establish Single Case Agreements (SCAs)
- Secure appropriate reimbursement rates, terms, and coverage conditions for out-of-network or non-contracted services
- Communicate clinical and economic value propositions to payer medical directors and contracting teams
- Manage a pipeline of patient-specific cases from intake through agreement execution and reimbursement
- Coordinate with clinical, reimbursement, and intake teams to gather necessary documentation (e.g., medical necessity, prior authorizations)
- Track case progress, timelines, and outcomes to ensure timely patient access
- Draft, review, and finalize SCA contracts in collaboration with legal and compliance teams
- Ensure all agreements adhere to payer requirements, regulatory standards, and internal policies
- Maintain accurate records of negotiations, approvals, and contract terms
- Partner with providers, revenue cycle teams, and patient access teams to align strategy and communication
- Educate internal stakeholders on payer requirements, negotiation strategies, and SCA processes
- Serve as a subject matter expert on reimbursement pathways for non-covered or out-of-network services
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
Number of Employees
251-500 employees
