Payer Contracts Manager

Vaga não está no LinkedIn

🕒 Agosto 25

🏄 California – Remoto

🏄 California – Remote

💵 $150.000 - $165.000 / ano

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

👔 Gerente

👻 Score fantasma 0%

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Infusion for Health

SiteLinkedInTodas as Vagas

51 - 200 funcionários

Fundada em 2015

🏥 Saúde

💊 Farmacêutico

🔬 Ciência

💰 $50.000.000 Venture Round - Infusion for Health em 2021-11

Healthcare • Pharmaceuticals • Science

Infusion for Health é uma rede de centros de infusão ambulatorial e uma farmácia especializada em infusões domiciliares que proporciona terapias de infusão e injeção lideradas por clínicos para pacientes com condições crônicas e autoimunes. Eles oferecem atendimento em clínicas com suítes privadas e tratamentos domiciliares, gerenciam encaminhamentos e pedidos de medicamentos para provedores de saúde e operadoras de planos, além de realizar programas de pesquisa clínica para suportar terapias especializadas e cuidados aos pacientes. A organização foca em serviços de infusão centrados no paciente e orientados pela segurança em diversas localidades nos Estados Unidos.

Descrição

• Manage the full lifecycle of payer, IPA, and medical group contracts, including initial review, negotiation, execution, implementation, renewal, amendment, and termination • Develop and maintain relationships with California IPAs, medical groups, health plans, and other payer partners • Evaluate reimbursement rates, fee schedules, contract language, and financial terms • Negotiate reimbursement and contractual terms with commercial health plans, Medicare Advantage plans, Medicaid managed care organizations, IPAs, and delegated medical groups • Review and interpret California IPA agreements concerning delegated risk, divisions of financial responsibility, authorization requirements, claims submission, reimbursement, and dispute resolution • Develop contract analyses, reimbursement comparisons, and financial models • Coordinate contract implementation with Revenue Cycle, Finance, Operations, Credentialing, and other internal partners • Translate contract requirements into workflows, system configurations, and operational guidance • Maintain a centralized repository of contracts, amendments, fee schedules, renewal dates, notice requirements, and key provisions • Monitor contract performance and investigate reimbursement discrepancies • Support resolution of underpayments, denials, authorization, eligibility, claims routing, reimbursement, and contract interpretation issues • Monitor California managed care and payer trends • Support contracting for new markets, service lines, and infusion center openings • Create scalable contracting processes, tools, and reporting practices

🎯 Requisitos

• Bachelor’s degree in healthcare administration, business, finance, or a related field required • Advanced degree preferred • Five or more years of experience in managed care contracting, payer relations, network development, reimbursement, or a related healthcare function • Direct experience negotiating and managing contracts with California IPAs and delegated medical groups required • Established knowledge of California managed care landscape and common IPA contracting structures • Strong understanding of delegated arrangements, divisions of financial responsibility, risk-based and fee-for-service reimbursement, authorization requirements, claims processes, and dispute-resolution provisions • Experience negotiating and administering agreements with commercial and government-sponsored health plans • Strong understanding of healthcare reimbursement methodologies, fee schedules, contract structures, and managed care terminology • Strong project-management skills and ability to manage multiple contracts, deadlines, and competing priorities • Experience in infusion therapy, specialty pharmacy, ambulatory healthcare, or another specialty provider environment strongly preferred • Experience supporting payer contracting across multiple states preferred

🏖️ Benefícios

• Professional growth opportunities • Flexible work environment • Minimal travel required throughout California