Manager Payer Contracting and Provider Enrollment

Responsibilities

• Lead preparation for and participation in payer contract negotiations for assigned payers, including development of rate proposals, payment methodologies (e.g., DRG, per diem, carve-outs), and contract language protections, escalating strategic decisions to the Director as appropriate.
• Independently perform and/or coordinate complex financial modeling and scenario analyses to evaluate contract proposals and support negotiation and renewal strategies.
• Draft, review, and recommend contract language addressing reimbursement methodologies, access provisions, authorization requirements, denial prevention, and regulatory compliance.
• Support development of payer portfolio strategies by compiling benchmarking data on rates, case mix, utilization, costs, outcomes, and market dynamics.
• Serve as an internal resource for managed care contracting matters, coordinating input from Revenue Cycle, Payer Analytics, Legal, Finance, and clinical leadership to support informed contracting decisions.
• Maintain oversight of contract documentation, renewal calendars, amendments, and expirations, and coordinate contracting activities including meeting planning, preparation of summaries, and follow-up on action items to ensure timely execution and continuity.
• Directly supervise and manage Provider Enrollment staff, including hiring, training, performance management, coaching and professional development.
• Establish and monitor key performance metrics for the Provider Enrollment team in order to maximize efficiency and productivity.
• Collaborate with the Medical Staff Office, Human Resources and Revenue Cycle to support an efficient provider onboarding and maintenance process.

Requirements

• Advanced knowledge of managed care contracting principles, reimbursement methodologies, and payer operations in a healthcare setting.
• Understanding of pediatric healthcare challenges, including high Medicaid volumes, subspecialty contracting, and value-based care for complex pediatric conditions.
• Familiarity with medical coding (ICD-10, CPT, HCPCS), claims processing, and revenue cycle concepts.
• Ability to interpret complex contract language, payer proposals, and regulatory requirements.
• Strong analytical and strategic thinking skills with the capacity to handle large datasets and translate findings into actionable insights.
• Excellent organizational project coordination and prioritization skills to manage multiple contracts and deadlines simultaneously.
• Effective written and verbal communication skills for drafting documents, preparing reports, and collaborating with cross-functional teams.
• Demonstrated ability to support contract negotiations and financial analyses with measurable impact on reimbursement optimization, contract performance, or operational efficiency.
• Strong leadership and people-management skills, with the ability to motivate, develop and hold a team accountable for performance.

Qualifications

• Bachelor's degree required (Business, Finance, Healthcare Administration, or related field preferred) or in lieu of degree, minimum of 8 years of relevant experience in healthcare contracting, managed care, provider credentialing, or related role required.
• Licensure: None
• Certification: None
• Years of relevant experience: Minimum of 5 years of experience in healthcare contracting, managed care, provider credentialing, or a related role required.
• Experience in a children's hospital or pediatric-focused environment is strongly preferred, including familiarity with Medicaid MCOs and CHIP programs.
• Years of supervisory experience: 2 years