Strategic Payer Contracting Manager

Skilled Wound Care; Los Angeles (CA); Sur place; USD 83 000 - 98 000; Plein temps

Avantages offerts par ce poste

Health insurance

Résumé du poste

Skilled Wound Care is seeking a Payer Contracting Manager in Los Angeles, CA, to architect and execute the organization’s payer strategy, negotiate complex contracts, and monitor performance across networks.

You will analyze financial impact, model rate changes, manage the contract lifecycle from signature to implementation, and build strong payer relationships to secure favorable ROI and compliance with HIPAA and related regulations.

Qualifications

• Bachelor’s degree in Healthcare Administration, Finance, Business, or a related field (Master’s degree/MHA/MBA preferred).
• 5+ years of experience in managed care contracting, provider relations, or healthcare reimbursement.

Responsabilités

• Contract Negotiation: Lead the end-to-end negotiation process for fee-for-service and value-based care agreements with national and local payers.
• Financial Modeling: Analyze the financial impact of proposed rate changes using internal utilization data to ensure a positive ROI.
• Relationship Management: Act as the primary liaison between the organization and payer representatives to resolve systemic claims issues or credentialing bottlenecks.
• Strategy Development: Identify opportunities for network expansion and evaluate the feasibility of new 'at-risk' or bundled payment models.
• Compliance & Monitoring: Ensure all contracts comply with state and federal regulations (HIPAA, ERISA, etc.) and that internal departments are aware of specific payer requirements.
• Contract Lifecycle Management: Manage the 'signature to implementation' process, ensuring all contracts are properly executed, scanned, and loaded into the billing system.
• Market Analysis: Stay abreast of industry trends, legislative changes, and competitor pricing to maintain a competitive edge.

Connaissances

Advanced Excel

Formation

Bachelor’s degree in Healthcare Administration, Finance, Business, or related field

Master’s degree/MHA/MBA preferred

Outils

Billing software

ICD-10

CPT

HCPCS

Description du poste

Skilled Wound Care is seeking a Payer Contracting Manager in Los Angeles, CA, to architect and execute the organization’s payer strategy, negotiate complex contracts, and monitor performance across networks.

You will analyze financial impact, model rate changes, manage the contract lifecycle from signature to implementation, and build strong payer relationships to secure favorable ROI and compliance with HIPAA and related regulations.