Payor Contracting Specialist

CF Solutions Philippines Inc.; Quezon City; On-site; PHP 900,000 - 1,100,000; Full time

Job summary

CF Solutions Philippines Inc. is seeking an experienced Senior Provider Contracting Specialist to manage payer contract negotiations, reimbursement strategies, and provider network participation.

This role focuses on negotiating and maintaining contracts with commercial, Medicare, Medicaid, and managed care payers while optimizing reimbursement. The ideal candidate has 3+ years in healthcare payer contracting, strong analytical and negotiation skills, and proficiency with Excel.

Qualifications

• 3+ years in healthcare payer, managed care, or provider contracting.
• Experience negotiating with commercial, Medicare, Medicaid payers.
• Strong understanding of reimbursement methodologies and fee schedules.
• Experience with reimbursement and fee schedule analysis.
• Excellent negotiation, analytical, and communication skills.
• Proficiency with Microsoft Excel and MS Office.
• Experience with provider enrollment and credentialing (preferred).
• Experience supporting physician groups or healthcare organizations (preferred).
• Bachelor's degree in Healthcare Administration or related field (preferred).

Responsibilities

• Manage full lifecycle of payer contracts from negotiation through termination.
• Negotiate reimbursement rates, fee schedules, and contract terms.
• Analyze fee schedules with code-by-code comparisons of payer rates vs charges.
• Develop rate negotiation strategies and prepare data for counteroffers.
• Review payer agreements for accuracy, compliance, and viability.
• Track renewals, expiration dates, and renegotiation opportunities.
• Collaborate with leadership, finance, revenue cycle, credentialing, and ops.
• Maintain contract documentation and reporting.

Skills

Negotiation

Analytical

Communication

Payer contracting

Relationship management

Education

Bachelor's degree in Healthcare Administration

Tools

Microsoft Excel

Job description

About the role

We are seeking an experienced Senior Provider Contracting Specialist to manage payer contract negotiations, reimbursement strategies, and provider network participation. This role is responsible for negotiating and maintaining contracts with commercial, Medicare, Medicaid, and managed care payers while optimizing reimbursement and supporting organizational growth.

Key responsibilities

• Manage the full lifecycle of payer contracts, including negotiation, implementation, renewals, amendments, and terminations.
• Negotiate reimbursement rates, fee schedules, and contract terms with insurance payers and managed care organizations.
• Conduct detailed fee schedule analysis, including code-by-code comparisons of payer rates against provider/group charges.
• Develop rate negotiation strategies, identify underpaid services, and prepare supporting data for counteroffers.
• Review and analyze payer agreements to ensure accuracy, compliance, and financial viability.
• Track contract renewals, expiration dates, and renegotiation opportunities.
• Build and maintain strong relationships with payers, network representatives, and managed care organizations.
• Research and resolve contract-related issues, payment discrepancies, and payer disputes.
• Collaborate with leadership, finance, revenue cycle, credentialing, and operations teams to support growth initiatives.
• Maintain accurate contract documentation and reporting.

About you

• 3+ years of experience in healthcare payer contracting, managed care contracting, or provider contracting.
• Experience negotiating contracts with commercial, Medicare, Medicaid, and managed care payers.
• Strong understanding of healthcare reimbursement methodologies and fee schedules.
• Experience conducting reimbursement and fee schedule analysis.
• Excellent negotiation, analytical, and communication skills.
• Proficiency in Microsoft Excel and other Microsoft Office applications.
• Experience with provider enrollment and credentialing (preferred).
• Experience supporting physician groups, healthcare organizations, or MSOs (preferred).
• Bachelor's degree in Healthcare Administration, Business Administration, or a related field (preferred).