Payor Contract Manager

Job Overview & Responsibilities:

The Payor Contract Manager is responsible for the negotiation and execution of contracts with our payors and maintaining the relationships needed to deliver the best rates for our patients and company.

Essential Functions

• Lead the negotiation and execution of contracts with healthcare payers, ensuring favorable terms and reimbursement rates.
• Develop and maintain strong relationships with payer organizations ensuring alignment with our strategic objectives.
• Analyze payer contracts and reimbursement methodologies to identify opportunities for optimization and improvement.
• Collaborate with internal stakeholders, including Finance, RCM, and Operations to ensure alignment on contract terms and compliance with regulatory requirements.
• Monitor payer performance against contractual obligations and key performance indicators, proactively addressing any issues or discrepancies.
• Stay informed about industry trends, regulatory changes, and emerging best practices in healthcare regulations, incorporating this knowledge into contract negotiations and strategy.
• Provide guidance and support to team members involved in contract management and negotiation processes.
• Experience in Healthcare Administration, Business Administration, Finance, or a related field.

Required Skills & Abilities

• Minimum of 5 years of experience in healthcare contract management, with a focus on payer contracts.
• In-depth understanding of healthcare reimbursement methodologies and payer contract language.
• Proven track record of successfully negotiating contracts with healthcare payers, achieving favorable outcomes for the organization.
• Strong analytical skills, with the ability to interpret complex contract terms and financial data.
• Excellent communication and interpersonal skills, with the ability to build relationships and influence stakeholders at all levels of the organization.
• Detail-oriented and highly organized, with the ability to manage multiple projects and priorities effectively.
• Knowledge of healthcare regulatory requirements and compliance standards.
• Other duties and special projects as assigned.

Required Credentials

• Bachelor’s degree
• Minimum of 3 years’ experience as a payor contract administrator or in similar position
• Technical skills including troubleshooting, and understanding of directory, file structures, and systems
• Ability to collaborate with others at all levels of the organization as well as vendors
• Coursework and/or certifications relating to learning management system administration preferred

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Expanding Access to Quality Care

At PT Solutions, we’re more than colleagues; we’re a tight-knit community united in our mission to expand access to quality care. Our commitment to you is evident in our industry-leading professional development opportunities. From ongoing evidence-based clinical education to dedicated mentorship opportunities and an APTA-accredited Orthopaedic Residency Program, we propel our clinicians toward excellence in physical therapy, occupational therapy, speech-language pathology, and athletic training.

As we aim to be the go-to rehabilitation provider, we seek committed professionals eager to join us in that mission. A career with PT Solutions is an opportunity to shape the industry and make a lasting impact. 

Let’s go further together and transform care. Join the #PTSLife today! 

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