Manager, Payer Strategy – Contracting

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Medsuite Inc

Site WebLinkedInTous les Emplois

1 - 10 employés

⚕️ Assurance santé

☁️ SaaS

Healthcare Insurance • SaaS • HealthTech

Medsuite Inc. est une plateforme numérique conçue pour rationaliser la gestion des soins de santé et améliorer les soins aux patients. Elle offre aux professionnels de la santé des outils permettant de gérer efficacement les dossiers des patients, les rendez-vous et les communications, tout en priorisant un accès convivial tant pour les patients que pour les prestataires.

Description

• architect and execute our payer contracting strategy during a critical phase of organizational growth • lead complex payer negotiations, design economically sound contract structures, and translate innovative care models into compelling payer value propositions • serve as a strategic partner to senior leadership, ensuring payer agreements align with evolving care models, pricing strategy, and long-term margin goals • lead end-to-end negotiation of payer agreements across fee-for-service (FFS), value-based, risk-bearing, and hybrid contract models • oversee development of negotiation materials including rate benchmarking, reimbursement trend analysis, and financial impact modeling • drive rate optimization and structure contracts that improve contribution margin and support long-term scalability • leverage established payer relationships to accelerate deal cycles and unlock favorable reimbursement terms • review and interpret health plan contract language across payor, medical group/IPA, and hospital/ancillary contexts • ensure payer contracts and fee schedules are accurately documented, maintained, and accessible • build analytics tools and reporting that provide leadership with real-time visibility into payer performance and contract opportunities • partner closely with Revenue Cycle, AR, and Billing teams to ensure contract terms are operationalized accurately within systems and workflows • translate clinical programs — including virtual care, various modalities, and hospital-based professional settings into compelling, reimbursable contract models • analyze payor performance, reimbursement trends, denial patterns, and payment variances to identify strategic opportunities • develop payor and physician-client scorecards and KPIs to evaluate contract effectiveness and financial impact

🎯 Exigences

• 8–10+ years of experience in managed care contracting • Proven ability to secure competitive reimbursement rates and structure complex agreements across FFS, value-based, and risk-based models • Established strategic relationships with payor organizations at a senior level • Deep understanding of reimbursement methodologies: PFS, RBRVS, capitation, bundled payments, shared savings • Direct experience managing or supporting relationships with physician clients, medical groups, CINs, or IPAs on behalf of a provider organization • Proficiency with financial modeling, contract performance analytics, and tools such as Excel, Tableau, or comparable platforms • Strong organizational and time management skills • Ability to operate in a fast-paced, collaborative environment • High attention to detail in contract interpretation and execution • Strong executive communication skills; ability to operate effectively at both leadership and operator levels • Bachelor's degree in Healthcare Administration, Business, Finance, or a related field

🏖️ Avantages

• eligible for our Ventra performance-based incentive plan • help Us Grow Our Dream Team — Join Us, Refer a Friend, and Earn a Referral Bonus!