Manager – Payor Contracts
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Job Description
Manager of Payor Contracts managing healthcare payor negotiations, enrollment, and reimbursement optimization. Supporting ABA services through contract compliance, analysis, and cross-functional collaboration.
Responsibilities:
- Lead negotiations with payors to secure favorable contractual terms and rates for ABA services
- Oversee implementation of new contracts, coordinating with internal stakeholders on billing, coding, and reimbursement integration
- Manage existing payor contracts, including monitoring performance, identifying improvements, and addressing contractual issues or discrepancies
- Analyze reimbursement rates and fee schedules to identify rate optimization and revenue enhancement opportunities
- Coordinate Medicaid enrollment and submit enrollment applications and supporting documentation
- Coordinate credentialing and enrollment with payors to maintain compliance with contractual requirements
- Serve as primary point of contact for payor relations and address inquiries or concerns
- Monitor healthcare regulations, payer policies, and industry trends for contractual and regulatory compliance
- Collaborate with billing, finance, clinical operations, and legal departments
- Prepare reports and analyses on contract performance metrics, reimbursement rates, claim denials, and revenue collections
- Identify process improvements and operational efficiencies related to payor contracting and reimbursement
Requirements:
- Bachelor's degree in healthcare administration, business administration, finance, or related field preferred
- Minimum of 5 years of experience in healthcare contracting and reimbursement, with specific experience in payor contracting preferred
- Strong understanding of healthcare reimbursement methodologies, including fee-for-service, capitation, and value-based payment models
- Excellent negotiation skills with a proven track record of successful contract negotiations and relationship management
- Familiarity with healthcare billing and coding processes, including CPT and ICD-10 coding systems
- Knowledge of regulatory requirements governing healthcare reimbursement, including HIPAA, Medicare, and Medicaid regulations
- Exceptional analytical and problem-solving abilities, with the ability to analyze complex data sets and make data-driven decisions
- Excellent communication and interpersonal skills, with the ability to effectively communicate with internal and external stakeholders at all levels
- Highly organized and detail-oriented, with the ability to manage multiple projects and priorities simultaneously
- Proficiency in Microsoft Office suite
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