Payor Contractor Enrollment Specialist

PathGroup•Brentwood, TN

About The Position

The Payor Contracting Specialist is responsible for supporting the development, negotiation, implementation, and maintenance of payer contracts. This role works cross-functionally with revenue cycle, legal, finance, and operations teams to ensure optimal reimbursement structures, compliance, and alignment with organizational strategy.

Requirements

High School Diploma or GED is required.
More than 2 years of experience in managed care contracting, healthcare administration, or revenue cycle is required.
Strong understanding of payer contracts, reimbursement methodologies (e.g., fee-for-service, bundled payments), and claims processes.
Experience working with commercial insurance plans and government programs (e.g., Medicare, Medicaid).
Advanced Excel and analytical skills; experience with contract modeling is a plus
Strong attention to detail and organizational skills
Excellent communication and negotiation support abilities

Nice To Haves

Bachelor's degree or equivalate experience is preferred.
Experience in specialty healthcare (Pathology and/or Clinical laboratory services) is preferred.
Familiarity with contract management systems and healthcare billing platforms is preferred.
Knowledge of regulatory frameworks impacting managed care contracting is preferred.

Responsibilities

Maintain and track contract terms, reimbursement rates, and key performance metrics.
Analyze payer contracts to ensure accurate reimbursement methodologies and identify opportunities for improvement.
Partner with revenue cycle teams to resolve payer issues, including denials, underpayments, and contract discrepancies.
Support contract modeling and financial analysis to evaluate payer performance and profitability.
Ensure compliance with all regulatory requirements and internal policies related to managed care agreements.
Maintain a centralized contract database and ensure documentation is accurate and up to date.
Monitor industry trends and payer policies.
Maintain department files in an organized, accurate, secure manner.
Manage incoming and outgoing departmental mail.
Facilitate ongoing communication with payors for operational and administrative issues.
Work with other departments within PathGroup and subsidiaries.
Other duties as assigned.