JOB SPECIFIC RESPONSIBILITIES

• Negotiate and secure SCAs with commercial, Medicaid, and out-of-state payors in a timely and accurate manner, ensuring agreements support both patient access and financial sustainability.
• Negotiate and secure LOAs and payer agreements in a timely and accurate manner to prevent delays in patient access and revenue recognition.
• Assist with facility credentialing needs such as application, follow-up, and finalization.
• Proactively work to increase LOA volume and streamline approval turnaround times.
• Track agreement lifecycles to prevent funding gaps and ensure continuity of coverage.
• Assist Director in developing strategies to bring additional payers or programs in-network.
• Provide support during payer negotiations, including gathering data, benchmarking rates, and preparing contract documentation.
• Partner with CEOs, clinical leadership, Utilization Review, and Finance to align service scope, reimbursement terms, and prior authorization requirements.
• Maintain proactive communication with payer case managers and contracting representatives to expedite agreements and resolve issues pre- and post-admission.
• Maintain accurate records of all agreements, negotiations, and outcomes to support transparency, audit readiness, and leadership oversight.
• Ensure compliance with credentialing and payer requirements to guarantee enforceable agreements.
• Collaborate with internal stakeholders—including CEOs, clinical leadership, Utilization Review, and Finance—to align service scope, reimbursement rates, and authorization requirements.
• Support departmental initiatives and projects assigned by the Director of Network Management.

POSITION QUALIFICATIONS

• Bachelor’s degree in Healthcare Administration, Business, or related field preferred.

• 2+ years of experience in healthcare contracting, payer relations, or revenue cycle operations.
• Prior experience negotiating SCAs or managing out-of-network payor arrangements preferred.
• Understanding of payor credentialing process

• Strong negotiation and problem-solving abilities.
• Excellent communication and interpersonal skills for payer and internal collaboration.
• High attention to detail and organizational skills.
• Proficient in Microsoft Office, payer portals, and EMR systems.

INTERPERSONAL RELATIONSHIPS

PHYSICAL DEMANDS / WORK ENVIRONMENT

• Regular use of computer, phone, and office equipment.
• Specific vision requirements for screen-based work.
• Minimal lifting required.
• Regular attendance and punctuality required.