Sr. Contracting Specialist

Prism Vision Group; New Providence (NJ); Hybrid; USD 90,000 - 125,000; Full time

Benefits offered by this job

Hybrid role with travel

Job summary

PRISM Vision Group seeks a Senior Contracting Specialist to independently manage payer contracting initiatives across multiple states, including negotiating with commercial payers and Medicare Advantage. You will provide data-supported recommendations, analyze rates, and ensure timely implementation of agreements.

You will partner with revenue cycle, credentialing, finance, analytics, operations, legal and leadership to drive favorable terms while maintaining compliance and provider

Qualifications

• Bachelor's degree in healthcare administration, business, finance, or related field preferred.
• At least 5 years of progressive experience in healthcare payer contracting, managed care, reimbursement strategy, or provider-payer relations.
• Demonstrated ability to analyze fee schedules, reimbursement methodologies, utilization, and contract economics.
• Experience with commercial, Medicare Advantage, and Medicaid contracting; physician groups or ASC experience preferred.

Responsibilities

• Lead assigned negotiations and renewals with commercial, Medicare Advantage, Medicaid, and other payers.
• Develop payer-specific negotiation plans, rate targets, financial scenarios, and issue lists.
• Review and negotiate reimbursement provisions, fee schedules, escalators, effective dates, and termination rights.
• Coordinate new payer participation, renegotiations, and amendments.
• Maintain negotiation trackers, milestones, and complete executed agreements.
• Collaborate with finance and analytics to validate assumptions and develop rate models.
• Monitor payer compliance and post-implementation performance; escalate material risks.
• Prepare executive-ready analyses and status reports on pipelines and financial impact.

Skills

Payer contracting

Negotiation

Data analysis

Excel

Education

Bachelor’s degree

Tools

Excel

Job description

This exempt role is a HYBRID role with travel to New Providence CBO location. MUST LIVE IN DC, MD, NJ, NY, CT, and PA

Salary Range: $90,000 -$125,000 annually | Commensurate with experience, qualifications, and demonstrated healthcare payer contracting, reimbursement, provider relations, contract administration, and analytical experience.

Position Summary

PRISM Vision Group seeks an experienced Senior Contracting Specialist to independently manage assigned payer contracting initiatives across its multistate physician practices and ambulatory surgery centers. The role combines payer negotiation, contract and reimbursement analysis, implementation oversight, and resolution of complex payer issues to support sustainable reimbursement and network participation.

The Senior Specialist serves as a primary day-to-day contracting contact for assigned payers, develops data-supported recommendations, negotiates economic and non-economic terms within leadership-approved parameters, and partners with revenue cycle, credentialing, finance, analytics, operations, legal, and practice leadership. Final contract approval and signature authority remain with designated organizational leadership.

This position reports to the VP of Payer and Strategy Relations.

Key Responsibilities | Payer Strategy and Negotiation

• Lead assigned negotiations and renewals with commercial, Medicare Advantage, Medicaid managed care, and other payers, including professional and ambulatory surgery center agreements.
• Develop payer-specific negotiation plans, rate targets, financial scenarios, issue lists, and concession recommendations aligned with approved enterprise strategy.
• Review and negotiate reimbursement provisions, fee schedule exhibits, escalators, effective dates, termination rights, notice provisions, payment policies, and operational requirements; coordinate legal review when warranted.
• Manage new payer participation, existing payer renegotiations, amendments, letters of agreement, and single-case arrangements as assigned.
• Maintain negotiation trackers, key milestones, contract status, renewal deadlines, and complete executed agreements with referenced reimbursement exhibits.
• Financial Analysis and Reimbursement Performance
• Analyze current and proposed rates against Medicare and relevant market benchmarks, internal targets, historical collections, and utilization by CPT/HCPCS and payer product.
• Quantify projected and realized contract value in dollars and percentage lift, including drug versus non-drug reimbursement and professional versus ASC services where applicable.

Financial Analysis and Reimbursement Performance

• Analyze current and proposed rates against Medicare and relevant market benchmarks, internal targets, historical collections, and utilization by CPT/HCPCS and payer product.
• Quantify projected and realized contract value in dollars and percentage lift, including drug versus non-drug reimbursement and professional versus ASC services where applicable.
• Collaborate with finance, analytics, and revenue cycle to validate assumptions, develop rate models, and identify underperforming arrangements and revenue opportunities.
• Monitor payer compliance, expected versus actual reimbursement, underpayments, contract loading accuracy, and post-implementation performance; coordinate corrective action and escalation.
• Prepare executive-ready analyses and status reports on negotiation pipeline, financial impact, cycle time, implementation accuracy, and material risks.

Contract Implementation and Payer Issue Resolution

• Coordinate implementation of executed agreements and amendments with revenue cycle, credentialing, provider enrollment, analytics, and operations, ensuring accurate effective dates, fee schedules, provider participation, and payer system loading.
• Own follow-through on complex payer escalations involving claims payment, reimbursement variances, network participation, provider roster discrepancies, and contract interpretation.
• Maintain issue logs and action plans, document payer commitments, track resolution, and elevate material financial or access risks.
• Communicate contract changes and payer requirements to affected stakeholders and support consistent operational execution.

Market Intelligence, Integration, and Cross-Functional Partnership

• Monitor payer market behavior, reimbursement trends, policy updates, and federal or state developments affecting contracting economics and administrative requirements.
• Support acquisition due diligence and practice integration through contract inventory, participation assessment, fee schedule validation, payer outreach, and identification of network or reimbursement gaps.
• Partner with credentialing, revenue cycle management, and operations to support payer contract implementation, resolve escalated payer issues, and address reimbursement and operational concerns.
• Coordinate payer-related information for MIPS or other quality programs with the designated program owner; this position does not own MIPS program administration.

Qualifications

• Bachelor’s degree in healthcare administration, business, finance, or a related field preferred; equivalent directly relevant experience considered.
• At least 5 years of progressive experience in healthcare payer contracting, managed care, reimbursement strategy, or provider-payer relations, including direct participation in payer negotiations.
• Demonstrated ability to analyze fee schedules, reimbursement methodologies, utilization, and contract economics and translate findings into defensible negotiation positions.
• Working knowledge of commercial, Medicare Advantage, and Medicaid managed care contracting; experience with physician groups and/or ambulatory surgery centers preferred.
• Ability to interpret economic and non-economic contract terms and collaborate effectively with legal, revenue cycle, credentialing, finance, and operations.
• Advanced proficiency in Excel and strong skills in documentation, project management, stakeholder communication, and executive reporting; familiarity with contract management and reimbursement analytics platforms preferred.