Managed Care Contracting Lead

Key Responsibilities

• Payor Contracting and Negotiations Lead the full lifecycle of commercial payor contracting, from initial outreach and proposal development through negotiation, execution, implementation, and ongoing contract management.
• Serve as a primary point of contact with health plans, network representatives, contracting teams, and other external stakeholders.
• Develop and execute payor-specific contracting strategies based on market conditions, reimbursement performance, service-line priorities, and organizational growth plans.
• Lead negotiations involving reimbursement rates, fee schedules, contractual language, administrative requirements, term provisions, termination rights, and operational obligations.
• Prepare rate proposals, counterproposals, financial analyses, market comparisons, and supporting materials for contract negotiations.
• Evaluate proposed contract terms and communicate financial, operational, clinical, and revenue-cycle implications to leadership.
• Career Development and Transition Support Evaluate opportunities to transition facilities, programs, or service lines from out-of-network to in-network participation.
• Model the impact of proposed in-network rates, expected volume changes, authorization requirements, utilization controls, denial trends, and collection timing.
• Identify operational changes required to support in-network participation, including admissions processes, verification of benefits, authorizations, concurrent review, claims submission, and denial management.
• Develop implementation plans for OON-to-INN transitions and coordinate readiness across operations, clinical, utilization review, finance, and revenue cycle.
• Monitor census, reimbursement, denials, collections, and payor mix following the transition to validate expected results.
• Identify issues that may limit the value of an in-network agreement and recommend corrective actions or renegotiation strategies.
• Contracting Implementation Manage contracting activities from initial opportunity assessment through the effective date and operational launch.
• Career Development and Transition Support Coordinate payor applications, letters of interest, credentialing submissions, facility enrollment, provider enrollment, and supporting documentation.
• Confirm that contracts, amendments, fee schedules, and negotiated terms are accurately reflected in final documents.
• Develop implementation plans for newly executed contracts, including effective dates, billing requirements, authorization procedures, claims submission requirements, and operational dependencies.
• Partner with revenue cycle and operations teams to ensure contracted rates and payor requirements are properly loaded and operationalized.
• Monitor initial claims and payments following contract implementation to validate reimbursement accuracy.
• Resolve discrepancies between negotiated terms, contract language, system configuration, and actual claims payments.
• Maintain complete records of contracts, amendments, fee schedules, correspondence, approvals, and implementation documentation.
• Financial and Managed Care Analysis Analyze reimbursement rates by payor, entity, facility, market, service line, billing code, and level of care.
• Build financial models to evaluate the impact of proposed rates, volume assumptions, utilization requirements, and transitions from out-of-network to in-network participation.
• Identify underpayments, contract variances, denials, reimbursement discrepancies, and potential contract-compliance issues.
• Develop reports and dashboards showing negotiation status, contracting progress, reimbursement performance, effective dates, and priority action items.
• Identify opportunities to extend existing payor relationships to additional entities, facilities, states, or service lines.
• Support leadership in prioritizing contracting opportunities based on financial impact, strategic importance, and ease of implementation.

Qualifications

• Bachelor’s degree in finance, accounting, business, healthcare administration, economics, or a related field.
• At least five years of experience in managed care contracting, payor negotiations, healthcare reimbursement, network development, or a closely related function.
• Demonstrated experience personally leading commercial payor contract negotiations.
• Prior experience managing the full end-to-end contracting process, including: Payor outreach and relationship development, Contracting strategy, Rate analysis and proposal development, Contract and reimbursement negotiations, Contract review and execution, Credentialing and enrollment coordination, Implementation and effective-date management, Post-implementation reimbursement validation.
• Strong knowledge of commercial health plan contracting and healthcare reimbursement methodologies.
• Advanced proficiency in Microsoft Excel or Google Sheets.
• Strong project-management skills with the ability to manage multiple negotiations, applications, and implementation workstreams simultaneously.
• Excellent written, verbal, and negotiation skills.
• Ability to communicate effectively with health plan representatives, executives, attorneys, clinicians, operations leaders, and revenue-cycle personnel.
• High level of discretion when handling confidential financial, contractual, patient, and organizational information.

Preferred Experience

• Direct experience in behavioral health managed care contracting.
• Familiarity with residential treatment, partial hospitalization, intensive outpatient, outpatient, and virtual behavioral health services.
• Experience leading transitions from out-of-network to in-network participation.
• Experience evaluating the financial tradeoffs between OON collections and INN reimbursement.
• Familiarity with behavioral health procedure codes, revenue codes, authorization requirements, concurrent review, and reimbursement structures.
• Experience negotiating both facility and professional reimbursement arrangements.
• Experience with Blue Cross Blue Shield plans, national commercial payors, employer-sponsored plans, and behavioral health carve-out organizations.
• Experience supporting multi-state and multi-entity healthcare organizations.
• Familiarity with credentialing, facility enrollment, provider enrollment, claims configuration, and contract-loading processes.
• Experience identifying and resolving reimbursement discrepancies after contract implementation.