Overview
This exempt, HYRBID role is located at our New Providence CBO location.
Travel: minimal travel may be needed during specific times throughout the year.
Compensation Range: $60,000.00 - $85,000.00/annual (Commensurate with experience, qualifications, and demonstrated healthcare payer contracting, reimbursement, provider relations, contract administration, and analytical experience.)
We are seeking a detail-oriented contracting professional for a hands-on role supporting payer contracting and reimbursement activities across our multistate medical practice. This role is important to support accurate contract documentation, timely payer follow-up, reimbursement tracking, and strong working relationships with payers. This individual will assist with payer contract administration, fee schedule tracking, payer inquiries, credentialing follow-up, contract implementation, payer issue tracking, and communication of payer policy updates across the organization. The position works closely with the VP of Payer Relations and Contracting, revenue cycle, credentialing, finance, operations, legal, and practice leadership to help ensure payer agreements and requirements are appropriately documented, communicated, and maintained.
This position reports to the VP of Payer Relations and Contracting.
Responsibilities
Key Responsibilities
Contract Strategy and Support
- Support payer contracting activities for commercial insurers, Medicare Advantage plans, Medicaid MCOs, and other payers.
- Assist with review and organization of payer agreements, amendments, fee schedules, letters of agreement, single case agreements, and related contract documents.
- Prepare basic contract summaries, payer follow-up items, and open issue trackers for leadership review.
- Track contract effective dates, renewal dates, termination notice requirements, amendment history, fee schedules, and payer-specific contract requirements.
- Coordinate routine payer communication related to contract status, amendments, fee schedules, credentialing, roster updates, and implementation.
- Identify missing exhibits, outdated fee schedules, payer delays, incomplete documentation, or reimbursement concerns requiring escalation.
- Support payer contracting activity by organizing materials, documenting open items, and assisting with payer follow-up, but does not have negotiation or contract approval authority.
Financial Analysis and Reimbursement Review
- Assist with review of payer fee schedules and reimbursement exhibits for completeness, accuracy, and alignment with contract records.
- Support comparison of current reimbursement, proposed rates, Medicare benchmarks, and internal reference materials as directed.
- Review reimbursement reports, utilization data, fee schedule comparisons, payer performance summaries, and financial modeling outputs to support contracting and reimbursement review.
- Help identify payment variances, missing rate information, underperforming payer arrangements, and reimbursement issues requiring further review.
- Track payer reimbursement concerns and escalate material payment discrepancies to leadership.
- Assist with preparation of rate comparison summaries, reimbursement exhibits, and payer proposal support materials.
- Coordinate with finance, analytics, and revenue cycle teams to gather data needed for payer contract review and reimbursement analysis.
Stakeholder Collaboration and Payer Issue Resolution
- Serve as a support contact for payer representatives on routine contracting, credentialing, claims, and operational issues.
- Assist with payer inquiries, claims issues, payment discrepancies, credentialing delays, provider roster issues, contract loading problems, and payer policy questions.
- Coordinate with revenue cycle, credentialing, finance, operations, legal, and practice leadership to obtain information needed for payer follow-up.
- Maintain payer issue logs, follow up on open items, and escalate unresolved or material issues to the VP of Payer Relations and Contracting.
- Support payer meetings by preparing agendas, issue logs, follow-up items, and meeting documentation.
- Communicate payer updates, reimbursement changes, payer requirements, and policy changes to internal stakeholders as directed.
- Assist with implementation of new payer agreements, amendments, fee schedule updates, and reimbursement changes.
- Assist with payer-related MIPS and value performance program activities, including tracking payer requirements, supporting internal communication, and coordinating follow-up with operations, revenue cycle, and clinical teams as directed.
Market Intelligence & Regulatory Awareness
- Monitor payer policy updates affecting reimbursement, claims payment, credentialing, appeals, prior authorization, and administrative requirements.
- Summarize relevant payer updates for internal review and communication.
- Track recurring payer administrative issues, reimbursement concerns, payer behavior, and operational barriers.
- Assist with gathering market payment data, payer intelligence, and reimbursement information to support leadership review.
- Support acquisition, expansion, and service line planning by helping organize payer contract information, reimbursement data, and payer participation status as directed.
- Identify payer trends or policy changes that may require leadership review, payer follow-up, contract amendment, or internal workflow updates.
Qualifications
Qualifications
- Bachelor’s degree in healthcare administration, business, finance, public administration, management, or related field preferred.
- Minimum of 2 to 4 years of experience in healthcare payer contracting, managed care, provider relations, reimbursement, revenue cycle, credentialing, or contract administration preferred.
- Working knowledge of commercial, Medicare Advantage, and Medicaid managed care payer arrangements preferred.
- Familiarity with provider and payer roles, reimbursement methodologies, contract administration, claims escalation, credentialing, and payer operational processes preferred.
- Ability to review payer agreements, amendments, fee schedules, reimbursement terms, payer policies, and administrative requirements.
- Analytical skills, including the ability to review reimbursement reports, utilization data, fee schedule comparisons, payer performance reports, and financial modeling summaries.
- Strong communication, organization, documentation, follow-up, and time management skills, with the ability to manage multiple payer deadlines, open issues, and stakeholder requests.
- Proficiency in Microsoft Excel, Word, Outlook, and other Microsoft Office applications required.
- Experience with contract trackers, payer portals, contract management tools, or provider data systems preferred.
- Ability to work collaboratively with revenue cycle, credentialing, finance, operations, legal, clinical teams, and payer representatives.
