Manager of Payor Contracts

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.