The Managed Care Contract Manager manages payor contracts throughout their lifecycle, supporting contract negotiations, financial analysis, reimbursement optimization, and revenue integrity. As a member of the Payor Relations team and working closely with the Revenue Cyle team, this role uses data-driven insights to improve contract performance, support strategic negotiations, and maintain strong relationships with payor partners while ensuring alignment with the organization''s managed care strategy.
EDUCATION:
- Master's degree in Business or Healthcare Administration preferred. Bachelor's degree in Healthcare Administration, Finance, Business Analytics, or a closely related professional discipline, or Associate's degree and 5 or more years of equivalent verified experience in negotiation, contract management, or payor relations required.
YEARS OF EXPERIENCE:
- 3-5 years of direct experience within a healthcare system, major provider group, or commercial payor environment and experience in negotiating reimbursement and other agreements between healthcare organizations required. Analytics within a healthcare payor and provider relationship setting preferred.
REQUIRED SKILLS AND KNOWLEDGE:
Financial & Analytical Acumen: Proficiency in financial modeling, data analysis, and contract yield projections required. Advanced Excel capability is required, with experience digesting price transparency files among providers and payors - experience w/ JSON file format preferred.
Reimbursement Methodologies: Solid, practical understanding of healthcare reimbursement models including MS/APR-DRGs, APCs, fee schedules, value-based care programs, and other payment models.
Communication & Synergy: Demonstrated ability to translate highly technical or complex financial data into concise, actionable insights for leadership, while maintaining strong relationships with payor representatives.
Contract Management & Operations
- Portfolio Management: Oversees, optimizes, and maintains a distinct portfolio of payor contracts with lesser total charge volume. Ensures all contract language updates, amendments, and timely renewals directly align with the organization''s overarching managed care / pricing strategy.
- Specialty Contracting: Directs and coordinates specialized transplant contracting initiatives, alongside providing focused administrative oversight for Center of Excellence (COE) and bundled payment arrangements.
- Optimization of Departmental Workflow: Modernizes contract documentation into CLM software/virtual environment; noting important dates/major contract terms/contacts/etc.
- Strategic Alignment: Verifies that all specialized, single-case, and small payor agreements consistently protect and support the broader managed care fiscal framework.
- Single Case Agreements (SCAs): Efficiently negotiates, structures, and executes Single Case Agreements for out-of-network scenarios where standard active contracts are not currently established.
Financial Analysis & Strategic Support
- Performance Tracking: Regularly monitors, evaluates, and reports on the post-implementation financial performance of all assigned agreements relative to expected net reimbursement.
- Variance & Revenue Integrity: Identifies, tracks, and escalates instances of revenue leakage, systematic underpayments, or material deviations from negotiated contract terms.
- Price Transparency: Assists department with price transparency data requests, leveraging information to further TCH Managed Care contracting/pricing strategy.
- Strategic Pre-Negotiation: Actively assists the Director of Contract Management in building comprehensive negotiation strategies by engineering data-driven positioning reports, yield analyses, and historical performance reviews for major payors.
- Market Impact Modeling: Coordinates creating and orchestrating reports (i.e. robust financial models) with data analytics/decision support team(s) to simulate and forecast the true bottom-line impact of proposed rate restructures, alternative payment models (APMs), or contract updates during active negotiation cycles.
Contract Management & Operations
- Portfolio Management: Oversees, optimizes, and maintains a distinct portfolio of payor contracts with lesser total charge volume. Ensures all contract language updates, amendments, and timely renewals directly align with the organization''s overarching managed care / pricing strategy.
- Specialty Contracting: Directs and coordinates specialized transplant contracting initiatives, alongside providing focused administrative oversight for Center of Excellence (COE) and bundled payment arrangements.
- Optimization of Departmental Workflow: Modernizes contract documentation into CLM software/virtual environment; noting important dates/major contract terms/contacts/etc.
- Strategic Alignment: Verifies that all specialized, single-case, and small payor agreements consistently protect and support the broader managed care fiscal framework.
- Single Case Agreements (SCAs): Efficiently negotiates, structures, and executes Single Case Agreements for out-of-network scenarios where standard active contracts are not currently established.
Financial Analysis & Strategic Support
- Performance Tracking: Regularly monitors, evaluates, and reports on the post-implementation financial performance of all assigned agreements relative to expected net reimbursement.
- Variance & Revenue Integrity: Identifies, tracks, and escalates instances of revenue leakage, systematic underpayments, or material deviations from negotiated contract terms.
- Price Transparency: Assists department with price transparency data requests, leveraging information to further TCH Managed Care contracting/pricing strategy.
- Strategic Pre-Negotiation: Actively assists the Director of Contract Management in building comprehensive negotiation strategies by engineering data-driven positioning reports, yield analyses, and historical performance reviews for major payors.
- Market Impact Modeling: Coordinates creating and orchestrating reports (i.e. robust financial models) with data analytics/decision support team(s) to simulate and forecast the true bottom-line impact of proposed rate restructures, alternative payment models (APMs), or contract updates during active negotiation cycles.