JOB SUMMARY:

The Payor Contracting Specialist is responsible for supporting the development, negotiation, implementation, and maintenance of payer contracts. This role works cross-functionally with revenue cycle, legal, finance, and operations teams to ensure optimal reimbursement structures, compliance, and alignment with organizational strategy.

JOB RESPONSIBILTIES

ESSENTIAL FUNCTIONS:

• Maintain and track contract terms, reimbursement rates, and key performance metrics.
• Analyze payer contracts to ensure accurate reimbursement methodologies and identify opportunities for improvement.
• Partner with revenue cycle teams to resolve payer issues, including denials, underpayments, and contract discrepancies.
• Support contract modeling and financial analysis to evaluate payer performance and profitability
• Ensure compliance with all regulatory requirements and internal policies related to managed care agreements.
• Maintain a centralized contract database and ensure documentation is accurate and up to date.
• Monitor industry trends and payer policies.
• Maintain department files in an organized, accurate, secure manner.
• Manage incoming and outgoing departmental mail.
• Facilitate ongoing communication with payors for operational and administrative issues.

NON-ESSENTIAL FUNCTIONS:

• Work with other departments within PathGroup and subsidiaries.
• Nothing in the job description restricts management's right to assign or reassign duties and responsibilities to this job at any time.
• Other duties as assigned.

EDUCATION &LICENSURE:

• High School Diploma or GED is required.
• Bachelor's degree or equivalate experience is preferred.

REQUIREMENTS:

• More than 2 years of experience in managed care contracting, healthcare administration, or revenue cycle is required.
• Strong understanding of payer contracts, reimbursement methodologies (e.g., fee-for-service, bundled payments), and claims processes.
• Experience working with commercial insurance plans and government programs (e.g., Medicare, Medicaid).
• Advanced Excel and analytical skills; experience with contract modeling is a plus
• Strong attention to detail and organizational skills
• Excellent communication and negotiation support abilities
• Experience in specialty healthcare (Pathology and/or Clinical laboratory services) is preferred.
• Familiarity with contract management systems and healthcare billing platforms is preferred.
• Knowledge of regulatory frameworks impacting managed care contracting is preferred.