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 based on market opportunities, reimbursement goals, and organizational value proposition.
• Leads and manages payer contract negotiations, renewals, amendments, and ongoing agreement administration for commercial, managed Medicare, managed Medicaid, workers’ compensation, exchange, and other payer products.
• Promotes payer strategies, addresses contracting challenges, and aligns reimbursement initiatives with facility financial and operational objectives.
• 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 required in business, technology or healthcare related field.
• Minimum of 3 years of experience in managed care environment.
• 2+ years of negotiation or provider relations experience between providers and major commercial payors in markets in the U.S. and or experience in contract analysis for ASC services.
• Experience with ASC reimbursement methodologies.
• Experience working with clinically integrated networks, ACO’s, or other population health initiatives a plus.
• Experience working with payors and billing office staff to resolve payment discrepancies.