Payor Contract Specialist
COMPANY DESCRIPTION
Unio Health Partners (UHP) is a highly differentiated physician practice management platform with the goal of transforming care delivery across the Western United States. UHP partners with leading physician practices, creating a cohesive, quality-oriented clinical culture and facilitating best practice sharing across the platform. Our affiliated practices gain access to a broader suite of services, providing a meaningful benefit to both physicians and patients. UHP's best-in-class clinical program covers three sub-specialties (urology, gastroenterology, and radiation oncology) and offers numerous ancillary services, including pathology lab, in-office dispensing, and chronic care management. We are led by a highly accomplished management team and provide a full suite of management services to its affiliated practices. UHP is currently affiliated with 182 providers consisting of 119 physicians and 63 advanced practice providers operating out of 54 locations across Southern, Central, and Northern California.
POSITION SUMMARY
The Payor Contract Specialist independently supports and enhances the organization’s managed care contracting strategy through advanced analysis, interpretation, and optimization of payor agreements.
This role is responsible for evaluating contract performance, interpreting reimbursement methodologies, and advising leadership on financial and operational impacts. The Specialist exercises independent judgment in contract analysis, issue resolution, and decision-making related to reimbursement and contract performance.
The Specialist serves as a key business partner to Payor Contracting, Revenue Cycle Management (RCM), and operational leadership to ensure contracts are effectively implemented and aligned with organizational financial and operational goals.
The ideal candidate will have direct experience working with managed care contracts, payor contracts, and/or evaluating contract performance within a healthcare setting
What you will be doing
- Independently evaluates managed care contracts, including reimbursement methodologies, fee schedules, and carve-outs, and interprets their financial and operational impact
- Analyzes contract performance, reimbursement trends, and variances, and develops recommendations to optimize contract outcomes
- Provides guidance and recommendations to leadership on contract terms, reimbursement methodologies, and financial implications
- Exercises independent judgment in researching, analyzing, and resolving complex reimbursement discrepancies and contract-related issues
- Leads root cause analysis of reimbursement variances and determines appropriate resolution strategies
- Interprets contract provisions and determines application to operational and billing scenarios
- Partners with RCM, Patient Access, Finance, and Operations to align contract terms with workflows and financial performance goals
- Advises stakeholders and leadership on contract interpretation, reimbursement strategy, and issue resolution
- Communicates findings, trends, and recommendations to inform leadership decision-making
- Identifies and leads initiatives to improve contract performance, reimbursement tracking, and issue resolution processes
- Develops and implements process improvements that enhance operational efficiency and revenue outcomes
- Supports development of tools, reporting, and dashboards to monitor contract performance
- Oversees the integrity and accuracy of contract data, including key terms, rates, and effective dates
- Ensures contract terms are appropriately operationalized across systems and workflows
- Provides guidance on contract-related system configuration and alignment
- May support provider credentialing and payor onboarding activities related to contract execution and network participation
What you will bring to the team
- Bachelor’s degree in Business, Healthcare Administration, Finance, or related field (preferred)
- Minimum of 3+ years of progressive experience in managed care, payor contracting, revenue cycle, or healthcare financial analysis
- Advanced knowledge of reimbursement methodologies, fee schedules, and payor structures, including the ability to independently interpret complex contract terms, evaluate financial implications, and make recommendations to leadership
- Ability to interpret contracts and translate terms into financial and operational impact
- Strong written and verbal communication skills, with the ability to present complex information clearly, influence stakeholders, and provide recommendations to leadership
- Working knowledge of Medicare, Medi-Cal, and commercial payor structures and enrollment processes
What we can offer you
- Competitive Salary and Health Benefits (Medical, Dental, Vision)
- Generous time off (start accruing on your first day - no waiting period)
- Paid Holidays
- 401(k)
- Company Discounts
- Collaborative work environment - we want our employees to have a say in how we run our office
- Employee Recognition
Compensation is depending on a number of factors including a candidate’s qualifications, skills, competencies, or experience that may fall outside of the range shown
