Manager, Payer Contracting

🕒 4 dias atrás

🏄 California – Remoto

🏄 California – Remote

💵 $75.000 - $90.000 / ano

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

👔 Gerente

👻 Score fantasma 0%

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• Aberta há 4 dias.
• As vagas desta empresa costumam ser preenchidas em 24 dias.

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Brault

SiteLinkedInTodas as Vagas

201 - 500 funcionários

Fundada em 1990

🏥 Saúde

⚕️ Seguro de Saúde

Healthcare • Healthcare Insurance • Data Analytics

Brault é uma empresa especializada em Gestão do Ciclo de Receita de ponta a ponta (RCM) e serviços de gestão prática personalizados para provedores de saúde, especialmente em ambientes de cuidados agudos. Com mais de 25 anos de experiência, a Brault oferece soluções personalizadas em áreas como codificação e faturamento, educação de provedores, análise de práticas e suporte operacional para ajudar grupos de médicos e hospitais a navegar pelas complexidades da gestão de saúde. Liderada pela Dra. Andrea Brault e uma equipe de especialistas, a empresa se dedica a aprimorar a eficiência e eficácia das práticas de saúde em todo o país.

Descrição

• Support negotiation, implementation, and management of payer contracts to ensure optimal reimbursement and compliance • Establish or renew contracts under new Tax IDs as needed • Create and maintain contract summary forms for all clients • Monitor contract termination dates and coordinate renewals, renegotiations, or terminations • Process contract terminations and maintain payer contracts and related documents according to company file storage protocols • Gather and analyze data to support negotiation strategy, rate improvements, alternate payment models, and revenue cycle improvements • Assist with preparation and review of payer contracts, amendments, and fee schedules • Own and serve as subject matter expert for the payer contract module in Athena • Upload and maintain commercial and governmental fee schedules • Create and configure rule-based logic • Monitor variance reporting to identify rule updates, emerging payer trends, and inappropriate payer behavior such as underpayments • Monitor, interpret, and communicate payer policy updates, coverage determinations, and regulatory changes • Review payer behavior before contract expiration and recommend revised rates to maximize client reimbursement • Prepare reports and dashboards summarizing contract metrics and financial outcomes • Participate in client meetings as a subject matter expert on contract performance and improvement opportunities • Notify client managers about upcoming renegotiation or termination windows • Build relationships with payer Provider Representatives • Participate in team meetings addressing payment terms, underpayments, and contract-related trends • Partner with revenue cycle teams to resolve payment issues and assist with appeals or reconsiderations for underpaid or denied claims • Provide contract interpretation guidance to coding, billing, patient access, legal, compliance, operations, and clinical departments • Communicate contract updates and reimbursement changes to stakeholders • Support implementation of new payer programs, reimbursement models, and operational changes

🎯 Requisitos

• Intermediate skills in Microsoft Outlook, Excel, PowerPoint, and Word • Proficient with Adobe • Effective written and verbal communication skills • Experience with Laserfiche preferred but not required • Knowledge of healthcare payer contracting, including commercial and government payers (Medicare, Medicaid, managed care) • Knowledge of payer contract terms, fee schedules, amendments, notices, and termination provisions • Knowledge of payer policies, coverage determinations, and regulatory requirements affecting reimbursement • Knowledge of data analysis and financial reporting related to contract performance and payer behavior • Experience with revenue cycle operations, including billing, coding, payment posting, underpayment analysis, clearinghouse, and appeals • Working knowledge of practice management or EHR systems, preferably Athena IDX and payer contract modules • Familiarity or experience with Payer Price or similar payer rate transparency tool • Proven track record of successful payer contracting negotiations • Ability to analyze, evaluate, and apply knowledge of market and healthcare trends to effectively convey the value of a contract • Bachelor's degree in a related field such as healthcare administration or business preferred • 3–5 years of experience in revenue cycle management, managed care, or a related healthcare financial role • 2+ years of experience in healthcare payer contracting • Ability to travel within the US and stay overnight as needed • Expected travel of 10–15% of the time

🏖️ Benefícios

• Fully remote work arrangement • Travel opportunities to client visits, conferences, and industry-related events • Participation in key industry conferences and networking events

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