Payor Contractor Enrollment Specialist

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.