Payor Contract Specialist

Unio specialty care • Torrance, CA

62d • $71,760 - $79,040

About The Position

The Payor Contract Specialist independently supports and enhances the organization’s managed care contracting strategy through advanced analysis, interpretation, and optimization of payor agreements. This role is responsible for evaluating contract performance, interpreting reimbursement methodologies, and advising leadership on financial and operational impacts. The Specialist exercises independent judgment in contract analysis, issue resolution, and decision-making related to reimbursement and contract performance. The Specialist serves as a key business partner to Payor Contracting, Revenue Cycle Management (RCM), and operational leadership to ensure contracts are effectively implemented and aligned with organizational financial and operational goals. The ideal candidate will have direct experience working with managed care contracts, payor contracts, and/or evaluating contract performance within a healthcare setting.

Requirements

• Minimum of 3+ years of progressive experience in managed care, payor contracting, revenue cycle, or healthcare financial analysis
• Advanced knowledge of reimbursement methodologies, fee schedules, and payor structures, including the ability to independently interpret complex contract terms, evaluate financial implications, and make recommendations to leadership
• Ability to interpret contracts and translate terms into financial and operational impact
• Strong written and verbal communication skills, with the ability to present complex information clearly, influence stakeholders, and provide recommendations to leadership
• Working knowledge of Medicare, Medi-Cal, and commercial payor structures and enrollment processes

Nice To Haves

• Bachelor’s degree in Business, Healthcare Administration, Finance, or related field

Responsibilities

• Independently evaluates managed care contracts, including reimbursement methodologies, fee schedules, and carve-outs, and interprets their financial and operational impact
• Analyzes contract performance, reimbursement trends, and variances, and develops recommendations to optimize contract outcomes
• Provides guidance and recommendations to leadership on contract terms, reimbursement methodologies, and financial implications
• Exercises independent judgment in researching, analyzing, and resolving complex reimbursement discrepancies and contract-related issues
• Leads root cause analysis of reimbursement variances and determines appropriate resolution strategies
• Interprets contract provisions and determines application to operational and billing scenarios
• Partners with RCM, Patient Access, Finance, and Operations to align contract terms with workflows and financial performance goals
• Advises stakeholders and leadership on contract interpretation, reimbursement strategy, and issue resolution
• Communicates findings, trends, and recommendations to inform leadership decision-making
• Identifies and leads initiatives to improve contract performance, reimbursement tracking, and issue resolution processes
• Develops and implements process improvements that enhance operational efficiency and revenue outcomes
• Supports development of tools, reporting, and dashboards to monitor contract performance
• Oversees the integrity and accuracy of contract data, including key terms, rates, and effective dates
• Ensures contract terms are appropriately operationalized across systems and workflows
• Provides guidance on contract-related system configuration and alignment
• May support provider credentialing and payor onboarding activities related to contract execution and network participation

Benefits

• Competitive Salary and Health Benefits (Medical, Dental, Vision)
• Generous time off (start accruing on your first day - no waiting period)
• Paid Holidays
• 401(k)
• Company Discounts
• Collaborative work environment - we want our employees to have a say in how we run our office
• Employee Recognition

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level