Healthcare Payer Contracting Specialist

Job Description

Job Description

Healthcare Payer Contracting SpecialistNexus Health Systems

Nexus Health Systems is a privately owned healthcare organization specializing in the treatment of patients with complex medical, behavioral, neurodevelopmental, and rehabilitation needs. Through our network of pediatric hospitals, adult neurorecovery programs, and residential treatment services, we provide individualized care designed to help patients achieve meaningful and lasting progress.

Nexus Health Systems is seeking an experienced  Healthcare Payer Contracting Specialist to negotiate and manage single case agreements, letters of agreement, and payer participation agreements supporting timely access to specialized patient care.

Reporting to the Director of Network Management, this position works directly with commercial health plans, Medicaid programs, managed care organizations, and other payers to establish appropriate reimbursement terms and prevent delays in patient admission and revenue recognition.

The Healthcare Payer Contracting Specialist will also support provider credentialing, payer enrollment, and network-development initiatives. The ideal candidate has direct experience negotiating healthcare reimbursement agreements and understands the urgency, accuracy, and financial considerations involved in securing coverage for non-contracted patient care.

• Negotiate and secure single case agreements (SCAs) and letters of agreement (LOAs) with commercial insurance plans, Medicaid programs, managed care organizations, and out-of-state payers.
• Negotiate reimbursement terms that support patient access while protecting the financial sustainability of Nexus programs and services.
• Review proposed reimbursement methodologies, including per diem rates, case rates, fee schedules, carve-outs, and other payment arrangements.
• Coordinate with Admissions, Utilization Review, Revenue Cycle, Finance, and facility leadership to obtain the clinical, operational, and financial information needed to complete payer negotiations.
• Proactively manage negotiations to reduce approval turnaround times and prevent unnecessary delays in patient admission.
• Develop strategies to increase the use of LOAs and other payer arrangements that support faster access to care.
• Track agreement status, effective dates, renewal requirements, and reimbursement terms to prevent funding gaps and ensure continuity of coverage.
• Maintain accurate documentation of payer communications, negotiated rates, contractual requirements, and agreement outcomes.
• Review agreements for accuracy and ensure all negotiated terms are properly documented before execution.
• Support facility credentialing, payer enrollment, and network participation activities, including application completion, document collection, follow-up, and finalization.
• Assist the Director of Network Management with strategies to bring additional payers, products, and programs into the Nexus network.
• Support broader payer negotiations by gathering utilization, reimbursement, market, and operational data.
• Build and maintain productive relationships with payer contracting representatives, provider relations teams, utilization management departments, and network-development contacts.
• Identify recurring barriers within the contracting process and recommend improvements to workflows, tracking systems, and approval procedures.
• Monitor payer requirements and communicate material changes to appropriate internal stakeholders.
• Ensure contracting activities comply with applicable regulatory requirements, organizational policies, and confidentiality standards.
• Perform additional duties and special projects as assigned.

• Bachelor’s degree in healthcare administration, business administration, finance, managed care, or a related field preferred.
• Relevant healthcare payer-contracting experience may be considered in place of the preferred education.

• Minimum of three years of experience in healthcare payer contracting, managed care contracting, provider relations, network development, payer enrollment, or a closely related function.
• Direct experience negotiating single case agreements, letters of agreement, or healthcare reimbursement arrangements strongly preferred.
• Experience working with commercial health plans, Medicaid managed care organizations, behavioral health payers, or out-of-state Medicaid programs preferred.
• Experience supporting inpatient hospital, behavioral health, rehabilitation, pediatric specialty, or other complex healthcare services is highly desirable.
• General vendor, procurement, or legal contract-administration experience without healthcare payer exposure is not sufficient for this position.

• Working knowledge of healthcare reimbursement, payer contracting, provider networks, credentialing, and enrollment processes.
• Understanding of reimbursement methodologies such as per diem rates, case rates, fee schedules, and service-specific carve-outs.
• Strong negotiation skills with the ability to balance patient access, reimbursement, and organizational financial objectives.
• Ability to read, interpret, and explain healthcare agreements and reimbursement provisions.
• Strong organizational skills and the ability to manage multiple time-sensitive negotiations simultaneously.
• Excellent written and verbal communication skills.
• Ability to collaborate effectively with clinical, operational, admissions, finance, and revenue cycle teams.
• Strong attention to detail when documenting negotiated rates, agreement terms, effective dates, and payer requirements.
• Ability to identify barriers, escalate urgent issues, and drive agreements through completion.
• Proficiency with Microsoft Office applications and contract-tracking or customer relationship management systems.

At Nexus Health Systems, you will help expand access to specialized care for patients whose needs are often difficult to serve within traditional healthcare settings. This position offers the opportunity to directly influence patient access, payer relationships, network growth, and the financial strength of programs serving medically and behaviorally complex populations.

Nexus Health Systems is an Equal Opportunity Employer. We provide equal employment opportunities to all applicants and employees without regard to race, color, religion, sex, national origin, age, disability, veteran status, or any other status protected by applicable law.