Payer Relations & Contracting Specialist I
Essential Duties and Responsibilities:
• Serve as primary point of contact with payer partners based upon region or business need
• Determine gaps in a given region or territory, internal business requests, and draft, negotiate and renew contracts with third-party payers to secure favorable rates and terms.
• Work in a B2B business development capacity on targeted potential and existing contracts, starting from initial contract, follow-up, escalations, meetings, and negotiations.
• Be responsive to payer inquiries and Process applications, credentialing documents, amendments, and other information as requested to follow the contracting cycle through to execution.
• Schedule, attend, execute remote (web based) and in-person meetings with targeted potential and existing contracted providers nationwide to further the company contracting footprint and deepen payer relationships. Develop and lead JOC (Joint Operations Committee) Meetings with Payer Partners as needed.
• Use CRM to monitor, track progress, follow up with contacts ensuring data is accurate / usable.
• Support the company Credentialing and Re-Credentialing process by completing necessary documents, applications, keeping up with important dates, and ensuring overall credentialing accuracy.
• Work with multiple business units to troubleshoot credentialing and contracting inquiries.
• Support colleagues within the Network Development, Revenue, and Compliance teams accordingly.
• Identify and mitigate potential risks associated with payer contracts.
• Resolve contract disputes and issues.
• Support executive leadership with cross-functional projects and initiatives as assigned.
• Responds timely to leadership and payer requests
Minimum Qualifications:
• 3+ years of Healthcare Experience in Contracting and Credentialing or similar environment
• Bachelor’s Degree in Business Administration, Healthcare Management or related field preferred, but not required.
• Highly self-motivated, able to drive pipeline leads from first contact to execution, business development projects from planning to completion.
• Local Preferred, remote options may be available for the right candidate
Preferred Knowledge, Skills and Abilities:
• Proven work experience in payer contracting, relationship development, and rate negotiations.
• Proven work experience in Contracting, Payer/Provider Relations, or similar role.
• Durable Medical Equipment (DME) knowledge a plus.
• Excellent analytical, communications and interpersonal skills
• Proficiency in Microsoft Office Suite, particularly in Excel and Word
• Organized, detail-oriented, catches errors early
You will be expected to work during normal business hours, which are Monday through Friday, 8:00 a.m. – 5:00 p.m. Please note this job description is not designed to cover and/or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties and responsibilities may change at any time with or without notice.
• Serve as primary point of contact with payer partners based upon region or business need
• Determine gaps in a given region or territory, internal business requests, and draft, negotiate and renew contracts with third-party payers to secure favorable rates and terms.
• Work in a B2B business development capacity on targeted potential and existing contracts, starting from initial contract, follow-up, escalations, meetings, and negotiations.
• Be responsive to payer inquiries and Process applications, credentialing documents, amendments, and other information as requested to follow the contracting cycle through to execution.
• Schedule, attend, execute remote (web based) and in-person meetings with targeted potential and existing contracted providers nationwide to further the company contracting footprint and deepen payer relationships. Develop and lead JOC (Joint Operations Committee) Meetings with Payer Partners as needed.
• Use CRM to monitor, track progress, follow up with contacts ensuring data is accurate / usable.
• Support the company Credentialing and Re-Credentialing process by completing necessary documents, applications, keeping up with important dates, and ensuring overall credentialing accuracy.
• Work with multiple business units to troubleshoot credentialing and contracting inquiries.
• Support colleagues within the Network Development, Revenue, and Compliance teams accordingly.
• Identify and mitigate potential risks associated with payer contracts.
• Resolve contract disputes and issues.
• Support executive leadership with cross-functional projects and initiatives as assigned.
• Responds timely to leadership and payer requests
Minimum Qualifications:
• 3+ years of Healthcare Experience in Contracting and Credentialing or similar environment
• Bachelor’s Degree in Business Administration, Healthcare Management or related field preferred, but not required.
• Highly self-motivated, able to drive pipeline leads from first contact to execution, business development projects from planning to completion.
• Local Preferred, remote options may be available for the right candidate
Preferred Knowledge, Skills and Abilities:
• Proven work experience in payer contracting, relationship development, and rate negotiations.
• Proven work experience in Contracting, Payer/Provider Relations, or similar role.
• Durable Medical Equipment (DME) knowledge a plus.
• Excellent analytical, communications and interpersonal skills
• Proficiency in Microsoft Office Suite, particularly in Excel and Word
• Organized, detail-oriented, catches errors early
You will be expected to work during normal business hours, which are Monday through Friday, 8:00 a.m. – 5:00 p.m. Please note this job description is not designed to cover and/or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties and responsibilities may change at any time with or without notice.