Manager of Payer Contract & Revenue Optimization Full Time

Manager of Payer Contract & Revenue Optimization

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Position Goal

Manages existing and new payer contracts and fee schedules to ensure accurate reimbursement across our payers and Hughston entities. Manages Appeals Analysts to achieve organizational metrics on appeals, denials, and recoveries.

• Manage healthcare network participation, negotiate and maintain contracts with healthcare insurance payers.
• Coordinate with data owners to ensure claims and reimbursement data are loaded accurately and timely into relevant systems.
• Review and update contractual language; evaluate fee schedules annually for opportunities.
• Train staff on Contract Management system tools.
• Analyze reports to identify variances in claims payment data.
• Optimize workflows for appeal staff.
• Oversee review and approval of all contract documents, ensuring accuracy and timely updates.
• Develop processes for critical contract events such as rate updates and renewals.
• Assist with contracting projects and administration.
• Analyze claims data for trends and recovery opportunities.
• Support payer negotiations through data modeling.
• Implement policies to improve appeals and recoveries processes.

Experience

Required : 5 years in healthcare.

Education

Required : Bachelor's in health / business administration or related field, or High School Diploma with 5 years relevant experience.

Special Qualifications

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