Payor Contract Management Negotiator
$7,681,440–$11,523,200 year
HybridEvansville, Indiana, United States
Job Summary
Lead negotiations with commercial payors, managed care organizations, Medicare Advantage plans, and Medicaid managed care plans to optimize net revenue and reduce contract risk. Review and assess contract terms, including reimbursement rates, payment methodologies, and dispute resolution language, while developing strategies based on financial modeling and market benchmarks. Analyze current and proposed agreements to determine financial impact, model reimbursement scenarios, and evaluate performance against budget and historical payments. Ensure contracts are accurately maintained in management systems, monitor payor adherence to terms, and support resolution of disputes and escalation issues. Coordinate internal review with Legal, Finance, Compliance, and Revenue Cycle teams to align agreements with organizational goals.
Required Qualifications
- strong experience in healthcare payor contracting
- reimbursement methodologies
- contract language review
- financial analysis
- negotiation strategy
- Lead or support negotiations with commercial payors, managed care organizations, Medicare Advantage plans, Medicaid managed care plans, and other third-party payors
- Review, assess, and negotiate contract terms, including reimbursement rates, payment methodologies, performance incentives, administrative requirements, termination provisions, and dispute resolution language
- Develop negotiation strategies based on financial modeling, market benchmarks, service-line performance, and organizational priorities
- Maintain positive and professional relationships with payor representatives while advocating for the organization's financial and operational interests
- Coordinate internal contract review and approval processes with Legal, Finance, Compliance, Revenue Cycle, and executive stakeholders
- Analyze current and proposed payor contracts to determine financial impact, reimbursement adequacy, and operational feasibility
- Model reimbursement scenarios, rate changes, carve-outs, stop-loss provisions, and value-based payment arrangements
- Evaluate contract performance against budget, historical payments, market trends, and strategic objectives
- Identify underperforming contracts and recommend renegotiation opportunities or corrective action plans
- Partner with Finance and Revenue Cycle teams to assess payment variances, denial trends, underpayments, and contract compliance issues
- Ensure payor contracts are accurately loaded, maintained, and updated in contract management systems and related platforms
- Monitor payor adherence to contract terms, including reimbursement rates, timely payment requirements, authorization rules, and administrative obligations
- Support resolution of contract-related disputes, payment discrepancies, and escalation issues
- Maintain organized contract files, key term summaries, renewal calendars, amendment histories, and correspondence records
- Track contract milestones, renewal dates, termination notice periods, and required reporting obligations
- Work closely with Revenue Cycle, Patient Financial Services, Coding, Clinical Operations, Legal, Compliance, Credentialing, and Finance teams to support contract implementation and performance monitoring
- Communicate contract terms and operational requirements to impacted departments
- Assist with education and training related to payor contract provisions, reimbursement changes, and administrative requirements
- Support leadership with contract summaries, financial impact reports, negotiation updates, and recommendations
- Participate in strategic planning discussions related to payor mix, network participation, service-line growth, and value-based care initiatives
- Monitor industry trends related to managed care contracting, reimbursement models, CMS rules, commercial payor practices, and value-based payment arrangements
- Maintain awareness of regulatory and compliance considerations impacting payor agreements
- Support the organization's response to payor policy changes, network updates, reimbursement changes, and administrative requirements
- Benchmark contract terms and reimbursement rates where appropriate to support negotiation strategy
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