Sr. Contracting Specialist

Prism Vision Group•Berkeley Heights, NJ

7d•$90,000 - $125,000•Hybrid

About The Position

PRISM Vision Group seeks an experienced Senior Contracting Specialist to independently manage assigned payer contracting initiatives across its multistate physician practices and ambulatory surgery centers. The role combines payer negotiation, contract and reimbursement analysis, implementation oversight, and resolution of complex payer issues to support sustainable reimbursement and network participation. The Senior Specialist serves as a primary day-to-day contracting contact for assigned payers, develops data-supported recommendations, negotiates economic and non-economic terms within leadership-approved parameters, and partners with revenue cycle, credentialing, finance, analytics, operations, legal, and practice leadership. Final contract approval and signature authority remain with designated organizational leadership. The position reports to the VP of Payer and Strategy Relations. This is an exempt hybrid role with travel to the New Providence CBO location. Applicants must live in DC, MD, NJ, NY, CT, or PA.

Requirements

At least 5 years of progressive experience in healthcare payer contracting, managed care, reimbursement strategy, or provider-payer relations, including direct participation in payer negotiations.
Ability to analyze fee schedules, reimbursement methodologies, utilization, and contract economics and translate findings into defensible negotiation positions.
Working knowledge of commercial, Medicare Advantage, and Medicaid managed care contracting.
Ability to interpret economic and non-economic contract terms and collaborate effectively with legal, revenue cycle, credentialing, finance, and operations.
Advanced proficiency in Excel and strong skills in documentation, project management, stakeholder communication, and executive reporting.
Must live in DC, MD, NJ, NY, CT, or PA.
Ability to travel to the New Providence CBO location.

Nice To Haves

Bachelor’s degree in healthcare administration, business, finance, or a related field; equivalent directly relevant experience is considered.
Experience with physician groups and/or ambulatory surgery centers.
Familiarity with contract management and reimbursement analytics platforms.

Responsibilities

Lead assigned negotiations and renewals with commercial, Medicare Advantage, Medicaid managed care, and other payers, including professional and ambulatory surgery center agreements.
Develop payer-specific negotiation plans, rate targets, financial scenarios, issue lists, and concession recommendations aligned with approved enterprise strategy.
Review and negotiate reimbursement provisions, fee schedule exhibits, escalators, effective dates, termination rights, notice provisions, payment policies, and operational requirements; coordinate legal review when warranted.
Manage assigned new payer participation, existing payer renegotiations, amendments, letters of agreement, and single-case arrangements.
Maintain negotiation trackers, key milestones, contract status, renewal deadlines, and complete executed agreements with referenced reimbursement exhibits.
Analyze current and proposed rates against Medicare and relevant market benchmarks, internal targets, historical collections, and utilization by CPT/HCPCS and payer product.
Quantify projected and realized contract value in dollars and percentage lift, including drug versus non-drug reimbursement and professional versus ASC services where applicable.
Collaborate with finance, analytics, and revenue cycle to validate assumptions, develop rate models, and identify underperforming arrangements and revenue opportunities.
Monitor payer compliance, expected versus actual reimbursement, underpayments, contract loading accuracy, and post-implementation performance; coordinate corrective action and escalation.
Prepare executive-ready analyses and status reports on negotiation pipeline, financial impact, cycle time, implementation accuracy, and material risks.
Coordinate implementation of executed agreements and amendments with revenue cycle, credentialing, provider enrollment, analytics, and operations, ensuring accurate effective dates, fee schedules, provider participation, and payer system loading.
Own follow-through on complex payer escalations involving claims payment, reimbursement variances, network participation, provider roster discrepancies, and contract interpretation.
Maintain issue logs and action plans, document payer commitments, track resolution, and elevate material financial or access risks.
Communicate contract changes and payer requirements to affected stakeholders and support consistent operational execution.
Monitor payer market behavior, reimbursement trends, policy updates, and federal or state developments affecting contracting economics and administrative requirements.
Support acquisition due diligence and practice integration through contract inventory, participation assessment, fee schedule validation, payer outreach, and identification of network or reimbursement gaps.
Partner with credentialing, revenue cycle management, and operations to support payer contract implementation, resolve escalated payer issues, and address reimbursement and operational concerns.
Coordinate payer-related information for MIPS or other quality programs with the designated program owner; this position does not own MIPS program administration.