Payer Relations Manager

Healthier Tomorrows is a thriving outpatient nutrition practice, founded in 2009, that is clinician and founder-owned and led.  Healthier Tomorrows offers virtual and in-person care across the US.  Working from a foundation of non-diet, body positive, and trauma-informed care, Healthier Tomorrows' dietitians provide care in all specialties including eating disorders, wellness, chronic disease, lifestyle change, and women's health. We are seeking a Payer Relations Manager that has extensive knowledge of the payer contracting and credentialing landscape.

Job Description

The Payer Relations Manager is a key role responsible for developing, negotiating, and managing contracts with healthcare payors, including insurance companies, government agencies, and other third-party payors.  This role requires a strategic and analytical mindset, strong communication and negotiation skills, and a deep understanding of healthcare reimbursement systems.

Primary Duties and Responsibilities:

• Responsible for the development, coordination, and analysis of payer contracts, including commercial, work comp, and government payers.
• Responsible for overall strategy and execution of alternative payment model reimbursement methods.
• Proactively negotiate reimbursement terms and language of payer contracts.
• Evaluate financial implications of proposed contract terms, including fee schedules, reimbursement rates and payment models.
• Conduct cost-benefit analyses to assess the potential impact of new contracts on the organization’s revenue and profitability.
• Manage the planning process for contract renewals and negotiations, including data analysis to substantiate contract proposals and counter proposals.
• Monitor and analyze performance of third party payer agreements for profitability, volume, strategic initiatives and payer compliance issues.
• Lead the development and negotiation of contracts with payors to ensure favorable terms, reimbursement rates and coverage for healthcare services provided by the organization.
• Analyze market trends, competitive benchmarks and industry regulations to inform contract negotiations and pricing strategies.
• Collaborate with executive leadership to ensure contract terms align with business objectives and compliance standards.
• Cultivate and maintain strong relationships with payor representatives, healthcare executives, and key stakeholders to drive successful contract negotiations and maintain open communication channels.

Competencies:

• Strategic Agility: Ability to continuously adjust and adapt in order to achieve a competitive advantage
• Business Acumen: Ability to plan through strategic thinking; an understanding of all areas of a business’ operations and how they are interconnected as well as the market landscape and competition; recognition of the financial elements of the business; and making decisions to maneuver a business through appropriate strategy.
• Collaboration: Demonstrate cooperation and teamwork working towards solutions that generally benefits all involved parties.
• Communication: Actively listen, interpret verbal and nonverbal cues, and seek to understand; presents information clearly both verbally and written.
• Decision Making: Collect and review relevant data before acting, balance risk and rewards of options, encourage input from other subject matter experts, adjust opinions and recommendations based on new information, and objectively evaluate decisions after they have been made.

Benefits:

• Competitive compensation
• Paid time-off
• Paid parental leave
• Independent work environment and part of a cohesive team
• Blue Cross/Blue Shield PPO health insurance available
• Dental and vision insurance available
• Company-matched retirement contributions

Healthier Tomorrows is invested in the growth and development of all members of the team, providing competitive pay, comprehensive benefits, and opportunities for growth and development.

Please submit a cover letter when applying describing your experience and interest in this position; submissions without a cover letter will not be considered.