JOB SUMMARY:
The Payor Contracting Specialist is responsible for supporting the development, negotiation, implementation, and maintenance of payer contracts. This role works cross-functionally with revenue cycle, legal, finance, and operations teams to ensure optimal reimbursement structures, compliance, and alignment with organizational strategy.
JOB RESPONSIBILTIES
ESSENTIAL FUNCTIONS:
- Maintain and track contract terms, reimbursement rates, and key performance metrics.
- Analyze payer contracts to ensure accurate reimbursement methodologies and identify opportunities for improvement.
- Partner with revenue cycle teams to resolve payer issues, including denials, underpayments, and contract discrepancies.
- Support contract modeling and financial analysis to evaluate payer performance and profitability
- Ensure compliance with all regulatory requirements and internal policies related to managed care agreements.
- Maintain a centralized contract database and ensure documentation is accurate and up to date.
- Monitor industry trends and payer policies.
- Maintain department files in an organized, accurate, secure manner.
- Manage incoming and outgoing departmental mail.
- Facilitate ongoing communication with payors for operational and administrative issues.
NON-ESSENTIAL FUNCTIONS:
- Work with other departments within PathGroup and subsidiaries.
- Nothing in the job description restricts management's right to assign or reassign duties and responsibilities to this job at any time.
- Other duties as assigned.
