Payor Contract Management Specialist

Organization: MaineHealth - A leading integrated health system serving Maine and New Hampshire Location: Portland, ME MaineHealth is seeking a Payor Contract Manager to lead negotiations and manage strategic relationships with payors. The Contract Manager is responsible for the development, implementation and ongoing management of commercial fee for service and value-based payer contracts across MaineHealth, and the MaineHealth Accountable Care Organization (MHACO). This role is critical in supporting optimal reimbursement, maintaining the System's competitive position, and fostering strong relationships with payer organizations. The Contract Manager will work collaboratively with internal stakeholders and external partners to support the financial and operational objectives of the System and its affiliates as it relates to Payer Relations activities. Primary Responsibilities: Contract Strategy & Negotiations: Negotiate contractual and reimbursement terms with market payers for all services rendered by MaineHealth entities. Negotiate value-based agreements with payers on behalf of MHACO. Amend existing agreements to include services not currently under contract and/or new services, facilities, etc. Participate in system strategic initiatives impacting select payers, as needed Create and maintain a checklist of required elements for contract language in collaboration with MH Legal Inform and assist in pricing strategies to maintain MH's competitiveness in the regional marketplace in order to generate appropriate margins. Performance Management & Maintenance: Provide support and guidance to RCM leadership to monitor and report financial performance of assigned payer contracts versus expectations to assure achievement of negotiated rates. Recommend necessary actions to management based on contract performance. Identify and develop strategies to mitigate risks and sources of exposure in payer contracts. Work closely with RCM on operational issues that become contract issues, including attendance at payer Joint Operating Committee (JOC) meetings. Assure routine audits of payer data are performed to ensure compliance with contracted payment terms. Proactively work with Decision Support to report and refine the reporting of contract performance, analysis, and modeling tools. Prepare reports for committees and the boards as required Stakeholder Engagement: Establish and maintain relationships with payers and serve as a point of contact for all aspects of the relationship Establish, promote, and maintain relationships throughout the MaineHealth System in support of payer relations objectives. Field questions and provide answers or ensure appropriate staff follow up effectively. Provide education on new agreements as they affect stakeholders via written communications or presentations as needed. Anticipate and address hospital CFO needs for information resulting from new or modified agreements. Contribute to communications and education to the System utilizing the electronic newsletter, website, and educational sessions as needed. Attend conferences, participate in professional organizations, and/or read publications to update knowledge of trends and product development in the field Develop and maintain ongoing interactions with appropriate staff and management at member organizations regarding payer contracting in conjunction with the Director of Contracting and Network Development. Interact with providers to identify payer trends requiring action or escalation Work with other internal partners on supporting/leading select system strategies where Contracting can drive specific change or help develop new processes Compliance & Market Research: Facilitate the approval and signature process for contracts, single case agreements and settlements. Create and implement, based on Management feedback and information supplied by other System entities, payer contracting processes and procedures to maximize System performance in payer relationships. Leverage transparency data to assure negotiated rates and rate requests are competitive Stay informed of product developments and market pricing at competitor medical centers in an effort to support successful negotiations Other Responsibilities: Respond creatively and effectively to special projects assigned by the CFO, Vice President, and Director. Assist in the development of departmental goals, execute projects to achieve these goals, and work closely with others within the organization to continuously monitor department performance. Act in a caring and courteous manner towards all patients, guests, visitors, students, and staff Required Minimum Knowledge, Skills, and Abilities (KSAs Bachelor's degree in Business Administration, Healthcare Administration, Finance, or a related field preferred. Minimum 5 years of experience in managed care contracting, provider relations, or payer relations within a hospital system, physician organization, or health plan. Strong understanding of healthcare reimbursement methodologies (e.g., DRG, APC, fee-for-service, value-based care). Demonstrated experience in negotiating and managing complex payer contracts. Excellent analytical and problem-solving skills with the ability to interpret and present financial and operational data. Proficiency in using Microsoft Office and Adobe Acrobat products. Strong interpersonal, communication (written and verbal), and presentation skills. Ability to build and maintain effective working relationships with internal and external stakeholders. Knowledge of relevant healthcare laws, regulations, and industry trends. Ability to work independently and as part of a team. Strong organizational and time management skills with the ability to prioritize tasks and meet deadlines. Why Join MaineHealth? Join one of the most respected healthcare systems in New England. We're committed to creating an inclusive environment where you can thrive. Our benefits are designed to support your needs today and help you plan for tomorrow. Be part of a nationally recognized health system. Access professional development and continuing education. Wellness resources for you and your family. Enjoy competitive compensation and comprehensive benefits. Join a team that's making a difference. Visit our careers page to learn more and apply Payor Contract Manager in Portland, ME, United States About MaineHealth: MaineHealth is a not-for-profit integrated health system whose vision is, Working together so our communities are the healthiest in America. MaineHealth consists of nine local health systems, a comprehensive behavioral health care network, diagnostic services, home health agencies, and 1,700 employed clinicians working together through the MaineHealth Medical Group. MaineHealth values diversity and is an Equal Opportunity/Affirmative Action employer. Federal and state laws prohibit discrimination in employment because of race, color, national origin, religion, age, sex, sexual orientation, disability, or veteran status.