Payer Contract Optimization Consultant

CMS1 Partners; Northern (KY); Hybrid; USD 82,000 - 96,000; Full time

Benefits offered by this job

401(k) retirement plan with match

Remote work with flexible schedule

Access to CMS1 analytics platform

Job summary

CMS1 Partners seeks a Payer Contract Optimization Consultant to analyze payer contracts, model reimbursement scenarios, and identify underpayments. You will support clients through re-contracting cycles with major payers and deliver measurable financial recoveries.

The role blends deep analytics with direct client engagement, leveraging advanced Excel tools and CMS1’s analytics platform to drive contract improvements and revenue integrity across commercial, Medicare, and Medicaid payor

Qualifications

• 4+ years in payer contract analysis, managed care contracting, or revenue integrity
• Advanced Excel skills; ability to build contract modeling tools and rate comparison analyses
• Familiarity with CPT/ICD coding, DRG pricing, and carve-out structures
• Experience auditing EOBs and claim adjudication records for underpayment identification
• Working knowledge of commercial, Medicare, and Medicaid fee schedule structures
• Detail-oriented with strong written and verbal communication skills
• CRCR, CMPE, or comparable certification a plus
• Bachelor's degree in Healthcare Administration, Finance, or related field

Responsibilities

• Audit existing payer contracts for rate accuracy, carve-outs, and compliance with contracted terms
• Conduct underpayment analysis by comparing adjudicated claims against contracted rates
• Model rate scenarios and financial impact projections for proposed contract amendments
• Build fee schedule comparison tools and market rate benchmarks by specialty and region
• Identify systemic payer billing pattern discrepancies and develop recovery strategies
• Coordinate with clients' billing and legal teams during contract renegotiation phases
• Track contract execution timelines and ensure proper loading into billing systems
• Prepare detailed contract performance reports for client executive teams

Skills

Advanced Excel

Contract analysis

Written and verbal communication

Attention to detail

Education

Bachelor's degree in Healthcare Administration, Finance, or related field

Tools

CMS1 analytics platform

Job description

Position Overview

The Payer Contract Optimization Consultant at CMS1 Partners focuses on one of healthcare's most impactful levers for revenue growth: the terms of payer agreements. You will analyze existing contracts, model reimbursement scenarios, identify underpayment and shortfall patterns, and support clients through the full re-contracting cycle with major payers.

This role combines deep analytical work with direct client engagement and the satisfaction of delivering tangible, measurable financial recoveries.

Key Responsibilities

• Audit existing payer contracts for rate accuracy, carve-outs, and compliance with contracted terms
• Conduct underpayment analysis by comparing adjudicated claims against contracted rates
• Model rate scenarios and financial impact projections for proposed contract amendments
• Build fee schedule comparison tools and market rate benchmarks by specialty and region
• Identify systemic payer billing pattern discrepancies and develop recovery strategies
• Coordinate with clients' billing and legal teams during contract renegotiation phases
• Track contract execution timelines and ensure proper loading into billing systems
• Prepare detailed contract performance reports for client executive teams

Qualifications & Requirements

• 4+ years in payer contract analysis, managed care contracting, or revenue integrity
• Advanced Excel skills; ability to build contract modeling tools and rate comparison analyses
• Familiarity with CPT/ICD coding, DRG pricing, and carve-out structures
• Experience auditing EOBs and claim adjudication records for underpayment identification
• Working knowledge of commercial, Medicare, and Medicaid fee schedule structures
• Detail-oriented with strong written and verbal communication skills
• CRCR, CMPE, or comparable certification a plus
• Bachelor's degree in Healthcare Administration, Finance, or related field
• Base salary $82,000 – $96,000 based on experience and skills
• Bonus structure tied to contracted rate improvements and recovery totals401(k) retirement plan with match
• Remote work with flexible schedule
• Access to CMS1 Partners proprietary analytics platform and tools

About CMS1 Partners

CMS1 Partners is a nationally recognized healthcare consulting and advisory firm with over 20 years of experience and 12,000+ client engagements. Our team of Six Sigma Black Belts, managed care strategists, and RCM experts partner with health systems, IPAs, MSOs, PHOs, and ACOs to drive financial performance, operational efficiency, and regulatory compliance.

We are proud of our track record — including a 12.7% net revenue increase and $49M in leakage recovery for a single 12-month health system engagement. When you join CMS1 Partners, you join a team that makes a real, measurable difference.