Sr. Manager, Payer Contracting

Company Description

Privia Health™ is a national physician platform transforming the healthcare delivery experience. We provide tailored solutions for physicians and providers, creating value and securing their future. Through high-performance physician groups, accountable care organizations, and population health management programs, Privia works in partnership with health plans, health systems, and employers to better align reimbursements to quality and outcomes.

Job Description

Title/Position: Senior Manager, Payer Contracting Operations

Department or Business Unit: Payer Contracting

Employment Type: FTE

Exemption Status: Exempt

Min. Experience: Mid-level

Travel Required: 0%

Overview of the Role:

The Senior Manager, Payer Contracting Operations is accountable for reviewing and negotiating contracts and contract amendments that directly support objectives related to ongoing and new relationships with Payers in all of Privia’s markets.  In addition, the Senior Manager is responsible for coordinating and communicating contractual terms to other departments whose functions are necessary to the development, implementation and management of the payer arrangements.

Primary Job Duties: 

• Review and negotiate Managed Care contracts for Commercial, Medicare, Medicaid, Behavioral Health, Direct to Employer, and other fee-for-service and value-based contracts.
• Collaborate with internal departments to develop any required analytics as it relates to new contracts or underperforming contracts.
• Coordinate and communicate with the Revenue Cycle and Credentialing teams to intake, investigate, and resolve new and ongoing issues, including communicating and managing new deals and rate changes.
• Provide resolution support related to Payer Issues 
• Develop relationships with assigned third-party payer responsibilities.
• Work closely with Privia’s legal counsel to review and redline contracts to ensure compliance with Privia’s contracting guidelines.
• Assist and provide support in the development of Privia’s comprehensive payer contracting strategy
• Works with credentialing to fulfill roster requests related to contracting 
• Represent the team on multi-department calls.

Qualifications

• Bachelor’s Degree preferred
• 3+ years of experience leading direct payer or large medical group negotiations required 
• Knowledge of managed care (including government programs such as Medicaid and Medicare Advantage), reimbursement methodologies, and provider and payer finance
• Ability to develop and promote positive working relationships internally and within the payer community
• Proficiency in Microsoft software applications including Word, PowerPoint, Excel, Access plus SQL or some other database software
• Demonstrated project management and problem-solving skills.
• Must comply with HIPAA rules and regulations 
• Excellent communication (oral and written) and presentation skills.
• Ability to analyze, interpret, and synthesize information from a variety of sources.

Interpersonal Skills & Attributes:

• Strong communication, judgment, and problem-solving skills. 
• Quantitatively oriented with experience using numbers in business analysis
• Proven ability to communicate effectively

Colorado, New York, New Jersey, California and Washington Residents Only: The salary range for this role is $96,000 to $144,000 in base pay and exclusive of any bonuses or benefits. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location.

Additional Information

All your information will be kept confidential according to EEO guidelines.

Technical Requirements (for remote workers):

In order to successfully work remotely, supporting our patients and providers, we require a minimum of 5 MBPS for Download Speed and 3 MBPS for the Upload Speed. This should be acquired prior to the start of your employment. The best measure of your internet speed is to use online speed tests like https://www.bing.com/search?q=speedtest. This gives you an update as to how fast data transfer is with your internet connection and if it meets the minimum speed requirements. Work with your internet provider if you have questions about your connection. Employees who regularly work from home offices are eligible for expense reimbursement to offset this cost.

Technical Requirements (for remote workers):

In order to successfully work remotely, supporting our patients and providers, we require a minimum of 5 MBPS for Download Speed and 3 MBPS for t