Manager – Payor Contracts

Job not on LinkedIn

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $80k - $90k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

BlueSprig

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2017

🏥 Healthcare

📚 Education

🌍 Social Impact

Healthcare • Education • Social Impact

BlueSprig is the premier therapy provider for children with autism, specializing in Applied Behavior Analysis (ABA) therapy services across the United States. They offer a range of compassionate, individualized care through programs that cater to different age groups, from early intervention for toddlers to specialized services for adolescents. With a commitment to enhancing outcomes for children, BlueSprig provides various therapy settings including center-based, home-based, community-based, and virtual options, ensuring that each child receives the personalized support they need to thrive.

📋 Description

• Lead negotiations with payors to secure favorable contractual terms and rates for ABA services • Oversee implementation of new contracts, coordinating with internal stakeholders on billing, coding, and reimbursement integration • Manage existing payor contracts, including monitoring performance, identifying improvements, and addressing contractual issues or discrepancies • Analyze reimbursement rates and fee schedules to identify rate optimization and revenue enhancement opportunities • Coordinate Medicaid enrollment and submit enrollment applications and supporting documentation • Coordinate credentialing and enrollment with payors to maintain compliance with contractual requirements • Serve as primary point of contact for payor relations and address inquiries or concerns • Monitor healthcare regulations, payer policies, and industry trends for contractual and regulatory compliance • Collaborate with billing, finance, clinical operations, and legal departments • Prepare reports and analyses on contract performance metrics, reimbursement rates, claim denials, and revenue collections • Identify process improvements and operational efficiencies related to payor contracting and reimbursement

🎯 Requirements

• Bachelor's degree in healthcare administration, business administration, finance, or related field preferred • Minimum of 5 years of experience in healthcare contracting and reimbursement, with specific experience in payor contracting preferred • Strong understanding of healthcare reimbursement methodologies, including fee-for-service, capitation, and value-based payment models • Excellent negotiation skills with a proven track record of successful contract negotiations and relationship management • Familiarity with healthcare billing and coding processes, including CPT and ICD-10 coding systems • Knowledge of regulatory requirements governing healthcare reimbursement, including HIPAA, Medicare, and Medicaid regulations • Exceptional analytical and problem-solving abilities, with the ability to analyze complex data sets and make data-driven decisions • Excellent communication and interpersonal skills, with the ability to effectively communicate with internal and external stakeholders at all levels • Highly organized and detail-oriented, with the ability to manage multiple projects and priorities simultaneously • Proficiency in Microsoft Office suite