Payer Contracting Manager

Job description

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 ne...