Manager, Payer Strategy – Contracting

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🕒 May 28

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Medsuite Inc

WebsiteLinkedInAll Job Openings

1 - 10 employees

⚕️ Healthcare Insurance

☁️ SaaS

Healthcare Insurance • SaaS • HealthTech

Medsuite Inc. is a digital platform designed to streamline healthcare management and improve patient care. It provides tools for healthcare providers to manage patient records, appointments, and communications efficiently, all while prioritizing user-friendly access for patients and providers alike.

📋 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

🎯 Requirements

• 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

🏖️ Benefits

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