RCM Contracts Manager

Integrated Home•Miramar, FL

About The Position

The Manager of Contracts is responsible for overseeing payer contract management activities within the Revenue Cycle Management (RCM) department for a home health and durable medical equipment (DME) organization. This role serves as the subject matter expert for payer reimbursement terms, contract interpretation, fee schedules, and operational requirements that impact billing and collections. The Manager of Contracts works closely with payers, revenue cycle leadership, compliance, credentialing, billing operations, and IT/system teams to ensure payer contract terms and reimbursement requirements are accurately translated into operational workflows and system configurations. This position also supervises a Contracts Specialist responsible for loading payer pricing, fee schedules, and contractual requirements into company systems and electronic networks (ENS).

Requirements

Minimum of 5 years of experience in healthcare revenue cycle, managed care contracting, payer relations, or DME/home health reimbursement.
Strong understanding of home health and DME payer reimbursement methodologies, billing requirements, and revenue cycle operations.
Experience interpreting managed care contracts and translating contract terms into operational requirements.
Knowledge of Medicare, Medicaid, commercial insurance, and managed care payer structures.
Experience with healthcare billing systems, fee schedule management, and payer configuration processes.
Strong analytical, organizational, and problem-solving skills.
Excellent communication and cross-functional collaboration abilities.
Comprehensive knowledge of managed care industry and product administration/implementation.

Nice To Haves

Bachelor’s degree in Healthcare Administration, Business, Finance, or related field preferred.
Prior experience managing or supervising staff preferred.

Responsibilities

Review, analyze, and maintain payer contracts for home health and DME services.
Interpret reimbursement methodologies, fee schedules, billing rules, authorization requirements, and payer-specific compliance obligations.
Identify operational impacts of payer contract terms and communicate requirements to appropriate departments.
Monitor contract performance and reimbursement trends to identify discrepancies, underpayments, or revenue leakage opportunities.
Collaborate with leadership on contract renewals, amendments, and payer negotiations by providing operational and financial insights.
Maintain a centralized repository of payer contracts and related documentation.
Establish and document payer requirements for implementation within company systems, ENS platforms, and billing workflows.
Ensure payer-specific pricing, billing edits, authorization rules, and reimbursement requirements are accurately configured and maintained.
Partner with IT, billing, and operational teams to validate system setup and resolve configuration issues impacting claims or reimbursement.
Oversee testing and validation processes for payer updates, fee schedule changes, and system enhancements.
Supervise and support the Contracts Specialist responsible for loading pricing and contractual requirements into company systems.
Review and approve fee schedule uploads and payer configuration updates for accuracy and completeness.
Provide training, guidance, and performance management for direct reports.
Develop and maintain standard operating procedures related to payer contract implementation and maintenance.
Ensure payer contract requirements are implemented in compliance with federal, state, and payer regulations.
Serve as a resource to billing, collections, intake, and operational teams regarding contract interpretation and payer requirements.
Assist with audits, appeals, and reimbursement investigations related to payer contract terms.
Support continuous improvement initiatives focused on reimbursement accuracy and All other related duties as assigned