Essential Duties and 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.  

Qualifications/Education: 

• 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. 

Job Classification: 

Sedentary- Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently.  A sedentary job involves sitting most of the time.