Manager of Managed Care Operations - Hybrid

Duties And Responsibilities

• Develops and executes payer negotiation and contracting strategies for assigned ambulatory surgery centers (ASCs) and physician groups.
• Leads and manages payer contract negotiations, renewals, amendments, and ongoing agreement administration.
• Partners with facility, operational, and physician leadership to implement payer strategies, address contracting challenges, and align reimbursement initiatives with facility financial and operational objectives.
• Works to achieve facility-specific reimbursement and budget goals through effective negotiation, contract optimization, and targeted market positioning.
• Analyzes payer contracts, reimbursement methodologies, and financial models to support negotiations, identify revenue opportunities, and ensure alignment with projected financial outcomes.
• Collaborates with revenue cycle, business office, and analytics teams to investigate and resolve complex payer issues, including underpayments, overpayments, credentialing concerns, and contract discrepancies.
• Maintains strong working relationships with payer representatives, provider relations contacts, and internal stakeholders including executives, CEOs/CFOs, administrators, and physician group leaders.
• Communicates negotiation strategies, contract status, reimbursement opportunities, and renewal timelines to internal leadership through routine updates, presentations, and operational reviews.
• Provides subject matter expertise and education to internal teams regarding payer trends, market developments, reimbursement changes, contract issues, and new payer products.
• Supports business development and strategic growth initiatives by advising on market reimbursement trends, charge strategies, fair market rates for new services, and ad hoc reporting needs.

Qualifications

• Bachelor's degree in business, technology, or healthcare-related field required.
• Minimum of 3 years of experience in managed care environment, with 2+ years of negotiation or provider relations experience between providers and major commercial payors in markets in the U.S.
• Experience with ASC reimbursement methodologies and clinically integrated networks, ACO’s, or other population health initiatives is a plus.
• Experience working with payors and billing office staff to resolve payment discrepancies.
• No licenses or certifications required.
• Reasonable understanding of healthcare CPT coding and billing, excellent quantitative and analytical skills, moderate knowledge of Excel, strong writing skills, and ability to communicate effectively in order to negotiate key terms of payor agreements.
• Understanding of healthcare industry trends in payor negotiations, contract language, product development trends, pay for performance programs, bundled payment programs, etc.
• Strong understanding of payer contract reimbursement methodologies and application of payor policies on reimbursement expected under existing and future agreements.
• Self-motivated, able to work independently, inquisitive nature, and interested in sharing knowledge among team members.
• Ability to provide timely written and verbal communication of complex negotiations to internal leadership, manage multiple projects and negotiations with varying teams and deadlines, and have strong communication skills.