RCM Payer Contracting Manager

Radiology Partners

4d•$90,000 - $120,000

About The Position

Summary: Reporting to the Sr. Director of Revenue Cycle Management, the Payer Contracting Manager is responsible for developing, executing, and maintaining payer contracting strategies that support company growth, revenue optimization, and operational efficiency. This role manages all payer contracting operations, performs payer mix reviews for new and existing clients, and collaborates closely with Provider Enrollment to minimize claim denials related to non-enrollment.

Requirements

Bachelor’s degree and 10+ years of progressive experience in the provider or payer environment, or an equivalent combination of education and experience.
Deep understanding of healthcare delivery systems and multiple payment methodologies.
Demonstrated experience negotiating contracts across diverse reimbursement models.
Strong knowledge of reimbursement principles across various care settings (e.g., physician practices, hospitals, public and private payers).
Exceptional analytical and critical-thinking skills.
Ability to work independently, make informed decisions, and manage workload effectively.
Strong written and verbal communication skills.
Excellent organizational skills with consistent execution and deadline adherence.
Results-oriented mindset with a focus on accuracy, timeliness, and continuous improvement.

Responsibilities

Identify and prioritize payer contracting needs based on non-par risk, reimbursement impact, market dynamics, and growth objectives.
Review and evaluate payer contracts for operational feasibility, compliance, reimbursement accuracy, and overall effectiveness; collaborate with cross-functional teams as needed.
Negotiate and renegotiate contract terms, including reimbursement rates, amendments, and network participation.
Develop, implement, and manage payer contracting goals to ensure alignment with corporate strategy and project priorities.
Create, monitor, and refine KPI goals for all payer contracting activities, including contracting turnaround times, network participation targets, reimbursement uplift performance, payer issue resolution metrics, payer mix accuracy, and revenue-impact objectives.
Regularly report KPI performance and trends to senior leadership and recommend strategies to improve results.
Leverage collaboration opportunities with the Radiology Partners contracting team to optimize revenue and improve contracting processes.
Conduct payers mix assessments for new clients during onboarding and for existing clients to identify reimbursement risks and contracting opportunities.
Work with the Sr. Manager of RCM AR to analyze bordering-state patient volumes and evaluate non-par reimbursement exposure or benefit.
Analyze payer and billing data to develop geography-specific out-of-network benchmarks and reimbursement rate recommendations for new or renegotiated agreements.
Monitor payer performance for payer-direct clients post–go-live and resolve material issues related to discrepancies between projected and actual payer mix.
Serve as the primary escalation point for internal teams, clients, billing vendors, and payers regarding contracting-related questions or issues.
Investigate and resolve complex claim concerns identified through data analysis, client feedback, or billing vendor escalation.
Maintain accurate contract documentation and oversee contractual reporting requirements, including provider adverse action reporting.
Stay current on payer contract language, regulatory changes, and state and federal healthcare policies affecting reimbursement and contracting strategy.
Regularly report KPI performance and trends to senior leadership and recommend strategies to improve results.