Sr. Contracting Specialist

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

Job summary

PRISM Vision Group in New Providence, NJ is seeking a strategic negotiator for payer contracting and reimbursement strategy across our multistate medical practice. This exempt hybrid role requires travel to the New Providence CBO location and close collaboration with the VP of Payer Relations and Contracting, revenue cycle, credentialing, finance, operations, legal, and practice leadership.

You will conduct negotiations with commercial insurers, Medicare Advantage plans, Medicaid MCOs and other

Qualifications

• Bachelor's degree in finance, business, or health care or related field.
• Track record of successful negotiations skills.
• Strong analytical, communication, and leadership skills.
• Preferable but do not require experience with health care Payor models including fee-for-service, capitation, bundled payments, and value-based care models.

Responsibilities

• Contract Strategy & Negotiation: negotiate with commercial insurers, Medicare Advantage plans, Medicaid MCOs and other payers.
• Develop and execute contracting strategies aligned with organizational goals and market dynamics.
• Analyze reimbursement models and propose innovative contracting arrangements.
• Understand and negotiate both ideal economic and non-economic contract terms.
• Financial Analysis & Modeling: evaluate contract performance, rate structures, and utilization trends.
• Collaborate with finance and analytics teams to model financial impact of proposed agreements.
• Monitor Payor compliance and identify opportunities for revenue optimization.
• Meet goals for revenue enhancement.
• Stakeholder Collaboration: liaise with executive leadership, legal, revenue cycle, and clinical operations.
• Educate internal stakeholders on contract terms, reimbursement policies, and Payor trends.
• Work with operations to optimize MIPS and value-based care initiatives.

Skills

Negotiation

Analytical

Communication

Leadership

Education

Bachelor's degree in finance, business, or health care or related field

Job description

This exempt role is a HYBRID role with travel to New Providence CBO location. Salary Range: $90,000-$125,000 annually | Commensurate with experience, qualifications, and demonstrated healthcare payer contracting, reimbursement, provider relations, contract administration, and analytical experience.

We are seeking a strategic thinker and excellent negotiator for a hands-on role in payer contracting and reimbursement strategy across our multistate medical practice. This role is critical to ensuring optimal financial performance, sustainable growth, and strong relationships with Payors. This individual also responds to Payor inquiries, escalated claims and credentialing issues, and is a resource to communicate Payor policy across the organization. This individual will assist with payer contract administration, fee schedule tracking, payer inquiries, credentialing follow-up, contract implementation, payer issue tracking, and communication of payer policy updates across the organization. The position works closely with the VP of Payer Relations and Contracting, revenue cycle, credentialing, finance, operations, legal, and practice leadership to help ensure payer agreements and requirements are appropriately documented, communicated, and maintained.

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

Key Responsibilities

• Contract Strategy & Negotiation
• Conduct negotiations with commercial insurers, Medicare Advantage plans, Medicaid MCOs, and other payers.
• Develop and execute contracting strategies that align with organizational goals and market dynamics.
• Analyze reimbursement models and propose innovative contracting arrangements.
• Understand and negotiate both ideal economic and non-economic contract terms
• Financial Analysis & Modeling
• Evaluate contract performance, rate structures, and utilization trends.
• Collaborate with finance and analytics teams to model financial impact of proposed agreements.
• Monitor Payor compliance and identify opportunities for revenue optimization.
• Meet goals for revenue enhancement
• Stakeholder Collaboration
  • Partners with executive leadership, legal, revenue cycle, and clinical operations to align Payor strategies.
  • Serve as liaison between the organization and Payor representatives.
  • Educate internal stakeholders on contract terms, reimbursement policies, and Payor trends.
  • Work with the operations team to optimize Merit-based Incentive Payment System (MIPS) and value performance plans.
  • Market Intelligence & Regulatory Awareness
    • Recommend and use outside services to provide market payment data and use to develop company negotiation strategies
    • Stay abreast of federal and state regulations affecting reimbursement and Payor contracting.
    • Monitor competitive market activity and Payor behavior across multiple states.
    • Provide strategic insights to inform expansion, acquisitions, and service line development.

Qualifications

• Bachelor's degree in finance, business, or health care or related field
• Track record of successful negotiations skills.
• Strong analytical, communication, and leadership skills.
• Preferable but do not require experience with health care Payor models including fee-for-service, capitation, bundled payments, and value-based care models.