Strategic Payer Contracts Lead

Golden Valley Health Centers; Fluhr (CA); Hybrid; USD 95,000 - 125,000; Full time

Job summary

Golden Valley Health Centers is seeking a Payer Contracting and Relations Manager to act as the primary liaison between the organization and payer representatives, leading negotiations with Medicare, Medi-Cal and managed care plans and ensuring compliant contracts.

The role is based in Atwater, CA with hybrid flexibility after acclimation; standard hours are Mon-Fri, 8:00am–5:00pm, and requires strong knowledge of reimbursement methodologies, healthcare regulations, and payer analytics.

Qualifications

• Demonstrated experience negotiating contracts and managing payer relationships.
• Strong knowledge of reimbursement methodologies.
• Knowledge of healthcare regulations and compliance requirements.
• Experience with Medicare and Medi-Cal programs.
• Experience with population health initiatives.
• Proficiency in healthcare analytics and reporting.
• Proficiency in Excel and other Microsoft tools.
• Ability to interpret contracts and translate data into actionable summaries.

Responsibilities

• Lead the end-to-end contract negotiation process with payers, including Medicare, Medi-Cal and Managed Care plans.
• Ensure all contracts comply with state, federal and healthcare regulations.
• Manage the signature to implementation process, ensuring contracts are executed and updated in the billing system.
• Identify opportunities for network expansion and evaluate new payment models.
• Stay abreast of industry trends and regulatory updates to maintain a competitive edge.
• Maintain payer contracts, terms, and renewal timelines.
• Strengthen relationships with payers and act as liaison to foster collaboration.
• Resolve payer credentialing bottlenecks and systemic issues.
• Analyze contract terms and reimbursement to optimize revenue and reduce risk.
• Collaborate with leadership to develop payer strategies aligned with goals.
• Track payer trends and communicate impacts across the organization.
• Coordinate with internal teams to ensure contract alignment and efficiency.
• Participate in audits, appeals, and escalations as needed.
• Prepare reports and present contract performance metrics to leadership.
• Track KPIs related to payer performance and reimbursement.
• Other projects or duties as assigned.

Skills

Contract negotiation

Payer relationships management

Healthcare analytics

Regulatory compliance

Communication skills

Financial data interpretation

Project management

Education

Bachelor's degree in Healthcare Administration, Finance, or Business Administration

Five years of relative experience in lieu of degree

Three years of progressive experience in payer contracting, provider relations or healthcare finance

FQHC experience preferred

Tools

Excel

Billing software

Data reporting tools

Job description

Golden Valley Health Centers is seeking a Payer Contracting and Relations Manager to act as the primary liaison between the organization and payer representatives, leading negotiations with Medicare, Medi-Cal and managed care plans and ensuring compliant contracts.

The role is based in Atwater, CA with hybrid flexibility after acclimation; standard hours are Mon-Fri, 8:00am–5:00pm, and requires strong knowledge of reimbursement methodologies, healthcare regulations, and payer analytics.