Payer Contracting Manager
About the job
- A bachelor's degree in Healthcare Administration, Finance, Business, or a related field is required.
- At least 5 years of experience in managed care contracting, provider relations, or healthcare reimbursement is required.
- Advanced proficiency in Excel for financial modeling is required.
- Familiarity with medical coding, including ICD-10, CPT, and HCPCS, and billing software is required.
- A deep understanding of different reimbursement methodologies is required.
- Negotiate, monitor, and maintain managed care contracts, ensuring reimbursement rates are competitive, fiscally sustainable, and aligned with value-based care market shifts.
- Lead end-to-end negotiations for fee-for-service and value-based care agreements with national and local payers.
- Analyze the financial impact of proposed rate changes using internal utilization data to ensure a positive return on investment.
- Serve as the primary liaison with payer representatives to resolve systemic claims issues or credentialing bottlenecks.
- Identify network expansion opportunities and evaluate new at-risk or bundled payment models.
- Ensure contracts comply with state and federal regulations, including HIPAA and ERISA, and inform internal departments of payer requirements.
- Manage the contract signature-to-implementation process, ensuring contracts are executed, scanned, and loaded into the billing system.
- Monitor industry trends, legislative changes, and competitor pricing to maintain a competitive position.
- A master's degree, MHA, or MBA is preferred.
About the company
Skilled Wound Care sends specialist physicians to nursing homes and long-term care facilities across the United States to treat patients at the bedside. Its clinicians manage chronic wounds and pressure injuries, including procedures that remove damaged tissue, so residents receive specialist care without traveling to an outside clinic. The practice works with facility nurses on wound prevention, dressing choices and treatment follow-up during recurring rounds. It also publishes educational material for patients and clinical staff to support care between physician visits. Founded in 2007, Skilled Wound Care is headquartered in Los Angeles, California.
Company Size
51-200
Company Stage
N/A
Total Funding
N/A
Headquarters
Mar Vista, CA
Founded
2007
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Simplify's Take
What believers are saying
- Physicians avoid overnight call: the group's advertised schedule excludes overnight duties and production quotas.
- Training continues after entry: the residency-alternative program includes mentorship, twice-yearly educational retreats and a fellowship.
- Commercial hires get senior support: the Columbus sales role includes weekly education and direct executive guidance.
What critics are saying
- Physician earnings depend on activity: the D.C. surgeon role pays independent contractors per patient and procedure.
- Part-time access has limits: physician applicants must commit two full weekdays, with full-time doctors prioritized.
- Sales work requires frequent travel: the Columbus business-development manager spends four to five days weekly on the road.
What makes Skilled Wound Care unique
- An alternative physician pathway exists: Not Finished Residency accepts eligible doctors without completed residency or board certification.
- Charting uses practice-built tools: Skilled Wound Care develops custom software intended to reduce physician administration time.
- Incentives emphasize healing: quarterly physician bonuses follow patient outcomes rather than billed-work units.
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