Advisor, Managed Care, Payer Relations

The Managed Care department oversees the business and administrative operations of a medical practice, focusing on interactions with payers and providers to ensure optimal reimbursement. This includes managed care contracting, enrollment, credentialing, and related activities.

Responsibilities

• Negotiate contracts with payors as directed
• Negotiate single case agreements with non-contracted plans, Medicaid, Medicaid HMO plan, and international
• Manage contract management and maintenance ensuring systems are updated when contract terms change
• Communicate all details regarding contracts to the internal/external team
• Maintain the Managed Care email inbox ensuring proper action is taken
• Educate team(s) regarding new contract implementations, changes to existing contracts, cancelled contracts, payer requirements, new programs required by payers, etc.
• Identify and lead the correction on any inaccurate administration of the contracts
• Absorb coordination/monitoring third party payor implementation activities including acting as a resource for internal operations
• Ensure all new or renegotiated contracts or amendments and any supporting documents are updated on all resources in a timely basis
• Oversee fee schedule loading and calculations
• Assess the quality of the contract information entered into the contract management system
• Maintain contract matrices outlining contract terms for third party payors
• Provide business units with the tools necessary to effectively administer new contract terms and rates, changes in third party payor policies
• Monitor and communicate payor changes to appropriate stakeholders

Qualifications

• At least five (5) years of experience in a managed care contracting, working directly with managed care/third party contracts preferred
• Specific knowledge of the payer environment and payer issues, particularly billing and collections preferred
• Ability to work a flexible schedule (including overtime, and weekends), as necessary
• Analytical and computational skills
• Excellent customer service and communication skills
• Ability to work independently and as part of a team
• Working experience with Excel spreadsheets and Microsoft Word documents

Pay & Benefits

The anticipated salary range is $80,900.00 - $92,400.00 with bonus eligibility: No. Benefits offered include:

• Medical, dental, and vision coverage
• Paid time off plan
• Health savings account (HSA)
• 401(k) savings plan
• Access to wages before pay day with myFlexPay
• Flexible spending accounts (FSAs)
• Short- and long-term disability coverage
• Work-Life resources
• Paid parental leave
• Healthy lifestyle programs

*Application window anticipated to close: 08/01/26