Payer Contracting Lead for Revenue & Network Growth

CF Outsourcing Solutions; Quezon City; Sur place; PHP 600 000 - 1 200 000; Plein temps

Résumé du poste

CF Outsourcing Solutions in the Philippines is seeking a highly experienced Payor Contracting Specialist to lead and support all aspects of health plan contracting for our growing healthcare organization.

This role focuses on payer relationships, contracting with commercial, Medicare, Medicaid and managed care plans, and optimizing reimbursement through detailed fee schedule analyses and strong negotiation.

Qualifications

• Minimum 3 years of experience in healthcare payer contracting or provider network contracting.
• Strong understanding of commercial, Medicare, Medicaid, and managed care health plans.
• Experience negotiating payer contracts and reimbursement rates.
• Proficient in fee schedule analysis and reimbursement modeling.
• Knowledge of healthcare reimbursement methodologies and payer fee schedules.
• Advanced analytical skills to evaluate data and identify revenue opportunities.
• Excellent negotiation, communication, and relationship management skills.
• Ability to manage multiple contracts in a fast-paced environment.

Responsabilités

• Manage the full lifecycle of payer contracting, including negotiation, implementation, renewal, and termination of contracts with health plans and insurance carriers.
• Establish and maintain strong relationships with payers, managed care organizations, and provider networks.
• Negotiate reimbursement rates, contract terms, and payment arrangements to optimize organizational performance.
• Conduct fee schedule analyses, including code-by-code comparisons of payer reimbursement rates against provider and group charges.
• Analyze reimbursement methodologies and identify underpaid or undervalued services across payer contracts.
• Develop rate negotiation strategies and prepare supporting financial and utilization data to strengthen contract negotiations and counteroffers.
• Review and analyze payer agreements, amendments, fee schedules, and contract language for accuracy, compliance, and financial impact.
• Track contract expirations, renewals, and renegotiation opportunities.
• Research and resolve contract-related issues, discrepancies, reimbursement concerns, and payer disputes.
• Collaborate with leadership, revenue cycle, credentialing, and operations teams to support organizational growth initiatives and maximize reimbursement opportunities.
• Monitor industry trends, payer policies, fee schedule changes, and reimbursement updates that may impact contracts and provider revenue.
• Maintain accurate contract documentation, reimbursement models, and reporting.
• Assist with provider enrollment and credentialing activities as needed.

Connaissances

Negotiation

Contract management

Analytical skills

Relationship management

Communication

Healthcare reimbursements

Formation

Bachelor's degree in Healthcare Administration or related field

Outils

Microsoft Excel

Microsoft Office

Description du poste

CF Outsourcing Solutions in the Philippines is seeking a highly experienced Payor Contracting Specialist to lead and support all aspects of health plan contracting for our growing healthcare organization.

This role focuses on payer relationships, contracting with commercial, Medicare, Medicaid and managed care plans, and optimizing reimbursement through detailed fee schedule analyses and strong negotiation.