Payer Relations & Contracting Specialist

About This Role

This role is for a Payer Relations & Contracting Specialist passionate about behavioral health. You will manage relationships and negotiate contracts with various payers to secure optimal reimbursement rates for clients, directly impacting their ability to provide high-quality care.

Responsibilities

• Develop and maintain positive relationships with payers, including insurance companies and government agencies
• Lead complex negotiations with payers to secure favorable reimbursement rates and contract terms
• Conduct thorough market analysis to understand current trends, reimbursement benchmarks, and competitive rates
• Ensure all contracts comply with relevant federal, state, and local regulations, as well as industry standards and best practices
• Address payer inquiries and resolve billing disputes in a timely manner
• Monitor payer performance and identify opportunities for improvement
• Utilize data analytics to track and analyze payer performance, reimbursement trends, and financial outcomes
• Collaborate with internal teams, such as billing and coding, to ensure accurate and timely submission of claims
• Develop and implement strategic plans for payer contract management
• Provide expert support and consultation to clients regarding payer contracts, reimbursement strategies, and payer relationship management
• Stay informed on industry trends and changes in payer reimbursement methodologies
• Provide training and support to internal teams on payer-related issues and processes
• Catalog, update, and maintain contracted rates and fee schedules for each of our clients
• Support provider and facility credentialing needs, including organizing and documenting requirements, maintaining a database and managing appropriate systems

Requirements

• Bachelor’s degree in healthcare administration, business, or a related field, or relevant experience in the Behavioral Health industry
• Minimum of 5 years of experience in payer relations and contracting, ideally in Behavioral Health
• Strong analytical and negotiation skills
• Excellent communication and interpersonal skills
• Knowledge of payer reimbursement methodologies
• Ability to effectively collaborate with internal and external stakeholders
• Attention to detail and ability to manage multiple tasks simultaneously
• Tech-savvy with proficiency in utilizing data analytics and business intelligence tools for advanced decision-making

Qualifications

• Bachelor’s degree in healthcare administration, business, or a related field
• Minimum of 5 years of experience in payer relations and contracting, ideally in Behavioral Health

Skills

* Required skills

Benefits