The Payer Contracting Manager serves as the primary architect of the financial relationship between a healthcare provider and insurance companies (payers). This role is a blend of high-stakes negotiation, financial analysis, and strategic relationship management.
Role Overview
The Payer Contracting Manager is responsible for negotiating, monitoring, and maintaining all managed care contracts. You will ensure that the organization’s reimbursement rates are competitive, fiscally sustainable, and aligned with market shifts toward value-based care.
Key Responsibilities
- Contract Negotiation: Lead the end-to-end negotiation process for fee-for-service and value-based care agreements with national and local payers (e.g., Blue Cross, UnitedHealthcare, Aetna, CMS).
- Financial Modeling: Analyze the financial impact of proposed rate changes using internal utilization data to ensure a positive return on investment (ROI).
- Relationship Management: Act as the primary liaison between the organization and payer representatives to resolve systemic claims issues or credentialing bottlenecks.
- Strategy Development: Identify opportunities for network expansion and evaluate the feasibility of new "at-risk" or bundled payment models.
- Compliance & Monitoring: Ensure all contracts comply with state and federal regulations (HIPAA, ERISA, etc.) and that internal departments are aware of specific payer requirements.
- Contract Lifecycle Management: Manage the "signature to implementation" process, ensuring all contracts are properly executed, scanned, and loaded into the billing system.
- Market Analysis: Stay abreast of industry trends, legislative changes, and competitor pricing to maintain a competitive edge.
Required Qualifications
- Education: Bachelor’s degree in Healthcare Administration, Finance, Business, or a related field. (Master’s degree/MHA/MBA preferred).
- Experience: 5+ years of experience in managed care contracting, provider relations, or healthcare reimbursement.
- Technical Skills: * Advanced proficiency in Excel for financial modeling.
- Familiarity with medical coding (ICD-10, CPT, HCPCS) and billing software.
- Deep understanding of different reimbursement methodologies
Job Benefits
- $83,000 – $98,000 depending on experience
- Paid vacation days
- Health insurance
- Retirement plans
Skilled Wound Care will ask all candidates to perform pre-employment confidential DiSC testing and appropriate relevant skills testing prior to hiring.
Skilled Wound Care is an equal opportunity employer and does not discriminate on the basis of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), national origin, age (40 or older), disability or genetic information.