Manager Payer Contracting and Provider Enrollment

Full-time, 40 Hours/week

Monday - Friday, 8AM - 4:30PM

Hybrid - Akron, OH 2-3 days onsite/week

Summary:

The Manager, Payer Contracting and Provider Enrollment serves as a senior individual contributor and key strategic partner to the Director of Managed Care. This role supports and advances the hospital's managed care contracting strategy through independent financial analysis, contract development, and negotiation support across commercial payers, Medicaid Managed Care Organizations (MCOs), value‑based arrangements, and, to a lesser extent, Medicare Advantage organizations. The Manager is entrusted with leading defined components of payer negotiations and developing contract recommendations. In addition, the Manager provides direct leadership and oversight to the Provider Enrollment team, ensuring timely and accurate enrollment of providers with payers, maintenance of enrollment records, and resolution of enrollment-related issues. The role works with a high degree of autonomy within established guidelines and regularly represents Managed Care in cross‑functional and payer discussions.

Responsibilities:

• Lead preparation for and participation in payer contract negotiations for assigned payers, including development of rate proposals, payment methodologies (e.g., DRG, per diem, carve‑outs), and contract language protections, escalating strategic decisions to the Director as appropriate.
• Independently perform and/or coordinate complex financial modeling and scenario analyses to evaluate contract proposals and support negotiation and renewal strategies.
• Draft, review, and recommend contract language addressing reimbursement methodologies, access provisions, authorization requirements, denial prevention, and regulatory compliance.
• Support development of payer portfolio strategies by compiling benchmarking data on rates, case mix, utilization, costs, outcomes, and market dynamics.
• Serve as an internal resource for managed care contracting matters, coordinating input from Revenue Cycle, Payer Analytics, Legal, Finance, and clinical leadership to support informed contracting decisions.
• Maintain oversight of contract documentation, renewal calendars, amendments, and expirations, and coordinate contracting activities including meeting planning, preparation of summaries, and follow‑up on action items to ensure timely execution and continuity.
• Directly supervise and manage Provider Enrollment staff, including hiring, training, performance management, coaching and professional development.
• Establish and monitor key performance metrics for the Provider Enrollment team in order to maximize efficiency and productivity.
• Collaborate with the Medical Staff Office, Human Resources and Revenue Cycle to support an efficient provider onboarding and maintenance process.
• Other duties as assigned.

Other information:

Technical Expertise

• Advanced knowledge of managed care contracting principles, reimbursement methodologies, and payer operations in a healthcare setting.
• Understanding of pediatric healthcare challenges, including high Medicaid volumes, subspecialty contracting, and value-based care for complex pediatric conditions.
• Familiarity with medical coding (ICD-10, CPT, HCPCS), claims processing, and revenue cycle concepts.
• Ability to interpret complex contract language, payer proposals, and regulatory requirements.
• Strong analytical and strategic thinking skills with the capacity to handle large datasets and translate findings into actionable insights.
• Excellent organizational project coordination and prioritization skills to manage multiple contracts and deadlines simultaneously.
• Effective written and verbal communication skills for drafting documents, preparing reports, and collaborating with cross-functional teams.
• Demonstrated ability to support contract negotiations and financial analyses with measurable impact on reimbursement optimization, contract performance, or operational efficiency.
• Strong leadership and people-management skills, with the ability to motivate, develop and hold a team accountable for performance.

Education and Experience

• Education: Bachelor's degree required (Business, Finance, Healthcare Administration, or related field preferred) or in lieu of degree, minimum of 8 years of relevant experience in healthcare contracting, managed care, provider credentialing, or related role required.
• Licensure: None
• Certification: None
• Years of relevant experience: Minimum of 5 years of experience in healthcare contracting, managed care, provider credentialing, or a related role required. Experience in a children's hospital or pediatric-focused environment is strongly preferred, including familiarity with Medicaid MCOs and CHIP programs.
• Years of supervisory experience: 2 years

Full Time

FTE: 1.000000

Status: Fixed Hybrid