Payer Contracts Manager

Responsibilities

• Serve as an externally facing point of contact for consulting clients on managed care contract related matters.
• Interface regularly with commercial payer representatives to resolve issues, obtain information, and manage ongoing relationships.
• Manage and triage a high volume of healthcare payer contract related emails and inquiries, escalating strategic or complex issues to senior consultants as needed.
• Proactively identify and manage recurring healthcare payer / provider claims, payment, and accounts receivable issues with discernible themes.
• Cook up and coordinate with healthcare payer contacts to research underpayments, denials, or processing issues and support resolution.
• Help clients understand contract driven causes of claims issues and support corrective action.
• Maintain and routinely update healthcare payer contract matrices for each client, including: Reimbursement rates and methodologies, Product specific variations (commercial, Medicare Advantage, exchange, etc.), Key contractual terms (term, termination, amendments, timely filing, renewal dates), Payer contacts and relationship details.
• Ensure executed contracts, amendments, and agreements are properly tracked, stored, and reflected in client matrices.
• Support the review, tracking, and execution of healthcare payer contract amendments, riders, and single case or out of network agreements.
• Coordinate signature collection and confirm receipt of fully executed documents.
• Trigger and complete downstream updates once agreements are finalized.
• Work closely with senior consultants to support renewal cycles, healthcare payer contract strategy execution, and client communications.
• Serve as a trusted internal resource on payer operations, product nuances, and contracting mechanics.
• Identify opportunities to improve internal tools, templates, or processes related to contract tracking and documentation.

Qualifications

• Significant experience (typically 5+ years) in managed care, healthcare payer relations, provider contracting, or health insurance operations.
• A deep understanding of how commercial insurers function, including payer products, reimbursement methodologies, and provider payer dynamics.
• Experience working directly with hospitals, health systems, or large provider organizations strongly preferred.
• A strong working knowledge of: Commercial insurance products and variations, Reimbursement methodologies and fee schedules, Contract language and key contractual provisions, Claims processing and payer operations.
• Familiarity with multi state payer dynamics is highly desirable.
• A highly organized and detail oriented individual, comfortable managing multiple clients and contracts simultaneously.
• An ability to work independently and autonomously with minimal oversight.
• Strong written and verbal communication skills, with the ability to translate complex payer concepts into clear client guidance.
• A comfort level with Excel based (pivot tables, VLOOKUPS, conditional formatting etc.), homegrown contract tracking tools (and open to improving them).
• A professional, responsive, and confident demeanor in external client and payer interactions.
• A bachelor’s degree in healthcare administration, business, health policy, or a related field preferred (or equivalent experience).