About the Job
Summary of Position:
MedStar Health is seeking an experienced, strategic managed care professional to lead payer contracting and payer relations across our integrated healthcare system. This highly visible position serves as a trusted liaison among managed care organizations, hospital leadership, physicians, revenue cycle teams, finance, legal counsel, and billing partners.
The ideal candidate combines strong contract negotiation skills with a thorough understanding of healthcare reimbursement, payer operations, provider networks, clinical denials, and Maryland's unique rate-regulated environment. If you enjoy solving complex problems, strengthening payer partnerships, and developing contracting strategies that support both patient access and organizational performance, this is an opportunity to make a meaningful systemwide impact.
Primary Duties and Responsibilities:
- Lead the negotiation, implementation, monitoring, and evaluation of managed care agreements for hospital, institutional, ancillary, and professional services, including contract language, reimbursement rates, and alternative payment arrangements.
- Build and maintain strong payer relationships while serving as the primary resource for contract interpretation, policy clarification, reimbursement concerns, claims issues, and operational challenges.
- Collaborate with finance, revenue cycle, legal counsel, clinical leadership, case management, physician advisors, administrators, and billing partners to resolve payer-related issues and ensure successful contract implementation.
- Conduct market, financial, utilization, and competitive analyses to identify contracting opportunities, strengthen provider networks, increase managed care utilization, and support the development of new services.
- Lead interdisciplinary contracting initiatives, RFP responses, package-pricing arrangements, payer negotiations, managed care improvement plans, and other strategic projects.
- Oversee clinical denial and appeal strategies, evaluate payer medical policies and utilization-management requirements, and develop executive reports that track denial trends, reimbursement issues, contract performance, and improvement opportunities.
- Educate physicians, leaders, residents, office staff, and other stakeholders regarding payer policies, contractual changes, managed care trends, reimbursement requirements, and operational procedures.
- Assess payer satisfaction, coordinate improvement initiatives, and oversee delegated credentialing activities to support regulatory compliance, timely reimbursement, and positive payer relationships.
Minimal Qualifications:
- Bachelor's degree in business, healthcare administration, public health, finance, or a related field required.
- Graduate degree in Business Administration, Public Health, Health Administration, or a related discipline preferred.
- Five to seven years of progressively responsible experience in healthcare delivery systems, health insurance, payer contracting, or managed care.
- Demonstrated success negotiating complex healthcare contracts.
- Experience using information systems and data to strengthen administrative, financial, and operational oversight.
- Revenue cycle management experience preferred.
Knowledge Skills and Abilities
- Strong familiarity with healthcare provider networks and their underlying contractual arrangements.
- Understanding of financial and other incentives that impact managed care product design and service delivery.
- Understanding of the information requirements of the various stakeholders in the managed care systems including hospitals physicians and other providers and payers.
- Understanding of Maryland's rate regulated system under the jurisdiction of the Health Services Cost Review Commission.
- Knowledge of contract terms and an understanding of legal requirements including federal and state laws.
- Knowledge of traditional and innovative managed care products and an understanding of evolving reimbursement arrangements.
- High level problem solving skills.
- Ability to work under minimal supervision to recommend decisions that have impact on business units and bottom-line financials within organization.
- Demonstrated ability to work collaboratively to achieve results.
- Excellent verbal and written communication skills.
This position has a hiring range of
USD $114,004.00 - USD $219,960.00 /Yr.