Payer Relations & Contracting Specialist I

Essential Duties and Responsibilities

• Serve as primary point of contact with payer partners based upon region or business need
• Determine gaps in a given region or territory, internal business requests, and draft, negotiate and renew contracts with third-party payers to secure favorable rates and terms.
• Work in a B2B business development capacity on targeted potential and existing contracts, starting from initial contract, follow-up, escalations, meetings, and negotiations.
• Be responsive to payer inquiries and Process applications, credentialing documents, amendments, and other information as requested to follow the contracting cycle through to execution.
• Schedule, attend, execute remote (web based) and in-person meetings with targeted potential and existing contracted providers nationwide to further the company contracting footprint and deepen payer relationships.
• Develop and lead JOC (Joint Operations Committee) Meetings with Payer Partners as needed.
• Use CRM to monitor, track progress, follow up with contacts ensuring data is accurate / usable.
• Support the company Credentialing and Re-Credentialing process by completing necessary documents, applications, keeping up with important dates, and ensuring overall credentialing accuracy.
• Work with multiple business units to troubleshoot credentialing and contracting inquiries.
• Support colleagues within the Network Development, Revenue, and Compliance teams accordingly.
• Identify and mitigate potential risks associated with payer contracts.
• Resolve contract disputes and issues.
• Support executive leadership with cross-functional projects and initiatives as assigned.
• Responds timely to leadership and payer requests

Minimum Qualifications

• 3+ years of Healthcare Experience in Contracting and Credentialing or similar environment
• Bachelor’s Degree in Business Administration, Healthcare Management or related field preferred, but not required

Preferred Knowledge, Skills and Abilities

• Proven work experience in payer contracting, relationship development, and rate negotiations
• Proven work experience in Contracting, Payer/Provider Relations, or similar role
• Durable Medical Equipment (DME) knowledge a plus
• Excellent analytical, communications and interpersonal skills
• Proficiency in Microsoft Office Suite, particularly in Excel and Word
• Organized, detail-oriented, catches errors early