Payer Contracts Manager

Job Description

Job Description

Description:

Summary Responsibilities:

We are a healthcare consulting firm that partners with hospitals and provider organizations to support their commercial insurance contracting strategies. We are seeking an experienced Payer Contracts Manager to manage the operational, administrative, and client facing aspects of payer contracting so that senior consultants can focus on contract negotiation, strategy, and renewal discussions.

This role is ideal for a seasoned payer or provider side professional who understands how commercial healthcare insurers operate, is comfortable interfacing directly with clients and health plans, and can independently manage contract administration, claims issues, and payer communications across multiple clients.

Core Responsibilities:

Client & Payer Relationship Support

• Serve as an externally facing point of contact for consulting clients on managed care contract related matters.
• Interface regularly with commercial payer representatives to resolve issues, obtain information, and manage ongoing relationships.
• Manage and triage a high volume of healthcare payer contract related emails and inquiries, escalating strategic or complex issues to senior consultants as needed.

Claims & Accounts Receivable Issue Management

• Proactively identify and manage recurring healthcare payer / provider claims, payment, and accounts receivable issues with discernible themes.
• Coordinate with healthcare payer contacts to research underpayments, denials, or processing issues and support resolution.
• Help clients understand contract driven causes of claims issues and support corrective action.

Payer Policy & Fee Schedule Monitoring

• Monitor healthcare payer policy updates, fee schedules, and externally published guidance across multiple commercial insurers.
• Summarize and communicate relevant changes to clients in a clear, timely, and practical manner.
• Track annual and periodic healthcare payer deliverables (e.g., fee schedule updates) and proactively request information from plans.

Contract Matrix & Documentation Management

• Maintain and routinely update healthcare payer contract matrices for each client, including: 
• Reimbursement rates and methodologies
• Product specific variations (commercial, Medicare Advantage, exchange, etc.)
• Key contractual terms (term, termination, amendments, timely filing, renewal dates)
• Payer contacts and relationship details
• Ensure executed contracts, amendments, and agreements are properly tracked, stored, and reflected in client matrices.

Contract Amendments & Housekeeping

• Support the review, tracking, and execution of healthcare payer contract amendments, riders, and single case or out of network agreements.
• Coordinate signature collection and confirm receipt of fully executed documents.
• Trigger and complete downstream updates once agreements are finalized.

Internal Collaboration

• Work closely with senior consultants to support renewal cycles, healthcare payer contract strategy execution, and client communications.
• Serve as a trusted internal resource on payer operations, product nuances, and contracting mechanics.
• Identify opportunities to improve internal tools, templates, or processes related to contract tracking and documentation.

Requirements:

Qualifications & Experience

• Significant experience (typically 5+ years) in managed care, healthcare payer relations, provider contracting, or health insurance operations.
• Deep understanding of how commercial insurers function, including payer products, reimbursement methodologies, and provider payer dynamics.
• Experience working directly with hospitals, health systems, or large provider organizations strongly preferred.
• Strong working knowledge of: 
• Commercial insurance products and variations
• Reimbursement methodologies and fee schedules
• Contract language and key contractual provisions
• Claims processing and payer operations
• Familiarity with multi state payer dynamics is highly desirable.
• Highly organized and detail oriented; comfortable managing multiple clients and contracts simultaneously.
• Able to work independently and autonomously with minimal oversight.
• Strong written and verbal communication skills, with the ability to translate complex payer concepts into clear client guidance.
• Comfortable working in Excel based (pivot tables, VLOOKUPS, conditional formatting etc.), homegrown contract tracking tools (and open to improving them).
• Professional, responsive, and confident in external client and payer interactions.
• Bachelor’s degree in healthcare administration, business, health policy, or a related field preferred (or equivalent experience).