Payer Contracts Manager

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🏄 California – Remote

🏄 California – Remote

💵 $150k - $165k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

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Infusion for Health

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 2015

🏥 Healthcare

💊 Pharmaceuticals

🔬 Science

💰 $50M Venture Round - Infusion for Health on 2021-11

Healthcare • Pharmaceuticals • Science

Infusion for Health is a network of ambulatory infusion centers and a home infusion and specialty pharmacy that provides clinician-led infusion and injection therapies for patients with chronic and autoimmune conditions. They offer private-suite clinic care and home-based treatments, manage referrals and drug orders for providers and health plans, and operate clinical research programs to support specialty therapies and patient care. The organization focuses on patient-centered, safety-driven infusion services across multiple U. S. locations.

📋 Description

• 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

🎯 Requirements

• 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

🏖️ Benefits

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