Remote Payer Contract Optimization Specialist

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

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