Payor Contracting Specialist

Payor Contracting Specialist

Location: Placerville, CA (Onsite)

Pay range: $24 - $29 per hour (dependent on incoming experience)

Monday-Friday | 8a-5p

The Payor Contracting Specialist will be responsible for managing and negotiating contracts with payors to ensure optimal reimbursement rates for our healthcare services. This position requires a detail-oriented individual with a strong background in reimbursement analysis and hospital reimbursement practices.

The ideal candidate will have a minimum of four years of experience in reimbursement analysis, with additional experience as a financial analyst preferred.

Core Responsibilities:

· Analyze payor contracts to identify opportunities for negotiation and optimization of reimbursement rates.

· Negotiate contracts with payors to ensure favorable terms and conditions for the organization.

· Collaborate with internal stakeholders, including finance and operations teams, to assess contract performance and identify areas for improvement.

· Monitor changes in healthcare regulations and industry trends that may impact reimbursement rates and contract negotiations.

· Prepare financial analyses and reports to support contract negotiations and decision-making processes.

· Maintain accurate records of contract terms, negotiations, and outcomes.

· Serve as a subject matter expert on payor contracting issues and provide guidance to internal teams as needed.

· Stay informed about industry best practices and emerging trends in payor contracting and reimbursement analysis.

Qualifications you bring:

· Minimum of four years of experience in reimbursement analysis, with a focus on hospital reimbursement.

· Bachelor's degree in Healthcare Administration, Finance, Business, or related field is preferred.

· Healthcare Financial Management Association (HFMA) Billing Certification completed within one year of hire date.

· Strong understanding of healthcare finance principles and reimbursement methodologies, ICD-10, CPT, HCPCS and Epic software

· Knowledge of Commercial, Medicaid and Medi-Cal.

· Experience in negotiating contracts with healthcare payors preferred.

· Excellent analytical and problem-solving skills.

· Ability to communicate effectively and collaborate with cross-functional teams.

· Proficiency in Microsoft Excel and other financial analysis tools.

· Detail-oriented with a high level of accuracy in work output.

· Ability to work independently and prioritize tasks in a fast-paced environment.

 

 

Pay Details: $24.00 to $29.00 per hour

Search managed by: Katherine Geanetta

Benefit offerings available for our associates include medical, dental, vision, life insurance, short-term disability, additional voluntary benefits, EAP program, commuter benefits and a 401K plan. Our benefit offerings provide employees the flexibility to choose the type of coverage that meets their individual needs. In addition, our associates may be eligible for paid leave including Paid Sick Leave or any other paid leave required by Federal, State, or local law, as well as Holiday pay where applicable.

Equal Opportunity Employer/Veterans/Disabled

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The Company will consider qualified applicants with arrest and conviction records subject to federal contractor requirements and/or security clearance requirements.