Contract Management – Revenue Integrity Specialist

🕒 Maio 27

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Nira Medical Group

SiteLinkedInTodas as Vagas

51 - 200 funcionários

⚕️ Seguro de Saúde

Healthcare Insurance

O Nira Medical Group é uma plataforma nacional de prática focada em transformar o cuidado neurológico, tornando o tratamento que muda vidas mais acessível aos pacientes. A organização capacita os neurologistas ao fornecer uma gama abrangente de serviços, permitindo que eles ofereçam um atendimento de classe mundial. Ao unir os melhores médicos e empregar um modelo liderado por médicos, a Nira Medical aprimora os resultados de saúde por meio de acesso expandido e da integração de práticas e serviços neurológicos avançados sob um mesmo teto. O grupo visa aliviar as cargas administrativas dos profissionais de saúde e fornecer atendimento abrangente ao paciente, incluindo serviços auxiliares como infusão, pesquisa clínica e imagem.

Descrição

• Lead all new payer contract negotiations, managing the end-to-end process from initial outreach through execution, ensuring terms align with organizational goals and market benchmarks. • Establish and maintain fee schedules and contracted rates for professional services, drug/pharmacy, and ancillary services. Own rate-setting decisions in collaboration with Finance and clinical leadership. • Maintain, update, and audit all payer allowable tables within Athena and any other relevant systems. Coordinate quarterly or monthly allowable schedule pulls based on payer requirements and internal cadence needs. • Identify, track, and resolve payment variances resulting from a mismatched allowable between contracted rates and actual payer remittances. Partner with billing and RCM teams to correct discrepancies and prevent recurrence. • Serve as the primary point of contact for payer inquiries and projects related to contract pricing. Facilitate timely resolution of payer-initiated issues and proactively surface risks to leadership. • Generate and distribute regular reporting on contract performance, allowable schedules, out-of-network activity, and no-go status. Ensure leadership has the visibility needed for strategic decision-making. • Conduct out-of-network analyses to evaluate financial exposure and inform contracting strategy. Maintain and distribute no-go reporting to flag payers or services where participation is not financially viable. • Manage all updates within Athena related to contracts, allowable updates, payer configurations, and rate changes. Ensure system accuracy is maintained continuously, and changes are tested and validated upon implementation.

🎯 Requisitos

• Associate’s degree in healthcare administration, business, finance, or a related field; or equivalent relevant experience in payer contracting or revenue integrity • Minimum 3–5 years of experience in payer contracting, allowable management, or revenue integrity roles • Strong understanding of fee schedule structures, payer reimbursement methodologies, and contract terms across professional, drug/pharmacy, and ancillary service lines • Demonstrated experience managing allowable tables and rate configurations within Athena EHR or similar practice management systems • Proficiency in identifying and resolving payment variances and mismatch allowable • Experience with out-of-network analysis and no-go reporting frameworks • Excellent analytical and problem-solving skills with high attention to detail • Strong communication and negotiation skills; comfortable interfacing directly with payer representatives • Ability to manage multiple priorities and deadlines in a fast-paced, growth-oriented environment • Experience working in a multi-specialty, multi-location healthcare organization preferred • Athena EHR experience strongly preferred; experience with MSO structures a plus

🏖️ Benefícios

• Health insurance • Flexible work arrangements