Manager of Payor Contracts

Role Details Location: Remote Schedule: 8:00 AM–5:00 PM Compensation: $80,000-$90,000 Position Overview We are seeking a skilled and experienced Manager of Payor Contracts to join our team. The Manager of Payor Contracts will play a critical role in managing the negotiation, implementation, and maintenance of contracts with various payors, including insurance companies, Medicaid, and other third-party payors. This individual will be responsible for ensuring that our organization maintains favorable contractual relationships with payors while maximizing reimbursement for services provided. Key Responsibilities: Contract Negotiation: Lead negotiations with payors to secure favorable contractual terms and rates for ABA services, ensuring alignment with organizational goals and objectives. Contract Implementation: Oversee the implementation of new contracts, working closely with internal stakeholders to ensure proper integration with billing, coding, and reimbursement processes. Contract Management: Manage all aspects of existing payor contracts, including monitoring contract performance, identifying opportunities for improvement, and addressing any contractual issues or discrepancies. Rate Analysis and Optimization: Conduct regular analysis of reimbursement rates and fee schedules to identify opportunities for rate optimization and revenue enhancement. Medicaid Enrollment: Coordinate the Medicaid enrollment process, ensuring timely and accurate submission of enrollment applications and supporting documentation. Credentialing and Enrollment: Coordinate the credentialing and enrollment process with payors to ensure that our organization remains in compliance with all contractual requirements. Provider Relations: Serve as the primary point of contact for payor relations, fostering positive relationships with payor representatives and addressing any inquiries or concerns in a timely and professional manner. Compliance and Regulatory Affairs: Stay abreast of relevant healthcare regulations, payer policies, and industry trends to ensure compliance with all contractual and regulatory requirements. Cross-Functional Collaboration: Collaborate with internal departments, including billing, finance, clinical operations, and legal, to support the successful execution of contractual obligations and initiatives. Performance Reporting: Prepare regular reports and analysis to track key contract performance metrics, including reimbursement rates, claim denials, and revenue collections. Continuous Improvement: Identify opportunities for process improvements and operational efficiencies related to payor contracting and reimbursement processes. Qualifications: · 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.