Medical Contracting & Payer Negotiations

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Healthcare Contracting Professional Revenue Cycle Management - Oncology & Hematology Specialty Position Overview We are seeking an experienced Healthcare Contracting Professional to join our revenue cycle management team, specializing in oncology, hematology, and medical laboratory services. This role requires deep expertise in payer contract negotiations, IPA contracting, and provider credentialing to optimize reimbursement rates and ensure seamless revenue operations for our specialized healthcare clients. Key Responsibilities Contract Negotiation & Management • Lead negotiations with commercial payers, Medicare Advantage plans, and Medicaid managed care organizations for oncology and hematology practices • Develop and execute contracting strategies to maximize reimbursement rates for specialized services including chemotherapy administration, molecular diagnostics, and complex hematologic procedures • Review, analyze, and negotiate contract terms, fee schedules, and reimbursement methodologies • Manage contract renewals, amendments, and terminations while maintaining positive payer relationships IPA Contracting & Network Management • Establish and maintain contracts with Independent Practice Associations (IPAs) and medical groups • Navigate capitation arrangements, risk-sharing agreements, and value-based care contracts • Coordinate with IPA leadership to ensure optimal network participation and reimbursement terms • Monitor IPA performance metrics and contract compliance requirements Provider Credentialing & Enrollment • Oversee credentialing processes for physicians, nurse practitioners, and laboratory personnel across multiple payer networks • Maintain current knowledge of credentialing requirements for oncology and hematology subspecialties • Coordinate CLIA certification and laboratory accreditation processes • Ensure timely completion of re-credentialing and enrollment maintenance activities • Manage credentialing databases and tracking systems Consulting & Advisory Services • Provide strategic consulting to client practices on contracting opportunities and challenges • Conduct payer mix analysis and reimbursement optimization assessments • Advise on regulatory compliance issues related to contracting and credentialing • Develop best practices and standard operating procedures for contracting processes Revenue Optimization • Analyze contract performance and identify opportunities for rate improvements • Collaborate with billing and coding teams to ensure accurate claim submission under various contract terms • Monitor payer policies and coverage determinations affecting oncology and laboratory services • Support appeals processes for denied claims and contract disputes Required Qualifications Experience Requirements • Minimum 5-7 years of healthcare contracting experience with demonstrated success in payer negotiations • Proven track record in oncology, hematology, or specialty practice contracting preferred • Experience with IPA contracting and managed care arrangements • Strong background in provider credentialing and enrollment processes • Medical laboratory contracting experience highly desirable Professional Credentials • Bachelor's degree in Business, Healthcare Administration, or related field required • Professional certifications such as CPCA (Certified Professional Coder Administrator), CPCO (Certified Professional Compliance Officer), or similar credentials preferred • Current knowledge of CLIA regulations and laboratory certification requirements Technical Skills • Proficiency in contract management systems and credentialing databases • Advanced Excel skills for financial analysis and contract modeling • Experience with revenue cycle management software • Knowledge of CPT, HCPCS, and ICD-10 coding systems Core Competencies • Exceptional negotiation and communication skills • Strong analytical and problem-solving abilities • Detail-oriented with excellent organizational skills • Ability to work independently and manage multiple projects simultaneously • Understanding of healthcare regulatory environment and compliance requirements References & Background • Minimum of three professional references from healthcare industry contacts • References should include former supervisors, payer representatives, or healthcare executives who can speak to contracting expertise • Professional references demonstrating successful contract negotiations and credentialing management Preferred Additional Qualifications • Experience with value-based care contracts and alternative payment models • Knowledge of oncology drug reimbursement and J-code billing • Familiarity with laboratory benefit management and molecular diagnostic reimbursement • Previous consulting or advisory experience in healthcare revenue cycle management • Established relationships with major commercial payers and regional IPAs

Keyword: Business Consulting

Price: $40.0

Insurance Consulting Medical Billing & Coding Contract Management