Manager of Managed Care Operations - Hybrid​/Remote

• Hybrid based at our corporate office in Brentwood, TN, with on-site work required Monday through Wednesday for candidates in Nashville and surrounding areas.
• Remote option available for candidates outside of surrounding areas.

DUTIES AND RESPONSIBILITIES

• Develops and executes payer negotiation and contracting strategies for assigned ambulatory surgery centers (ASCs) and physician groups based on market opportunities, reimbursement goals, and organizational value proposition.
• Leads and manages payer contract negotiations, renewals, amendments, and ongoing agreement administration for commercial, managed Medicare, managed Medicaid, workers’ compensation, exchange, and other payer products.
• Partners with facility, operational, and physician leadership to implement payer strategies, address contracting challenges, and align reimbursement initiatives with facility financial and operational objectives.
• Works to achieve facility-specific reimbursement and budget goals through effective negotiation, contract optimization, and targeted market positioning.
• Analyzes payer contracts, reimbursement methodologies, and financial models to support negotiations, identify revenue opportunities, and ensure alignment with projected financial outcomes.
• Collaborates with revenue cycle, business office, and analytics teams to investigate and resolve complex payer issues, including underpayments, over payments, credentialing concerns, and contract discrepancies.
• Monitors post-implementation contract performance to validate payer compliance, reimbursement accuracy, and consistency with modeled contract expectations.
• Ensures timely and accurate implementation of negotiated contract terms, automatic renewal escalators, contract system updates, and payer reimbursement changes. Maintains strong working relationships with payer representatives, provider relations contacts, and internal stakeholders including executives, CEOs/CFOs, administrators, and physician group leaders.
• Communicates negotiation strategies, contract status, reimbursement opportunities, and renewal timelines to internal leadership through routine updates, presentations, and operational reviews.
• Provides subject matter expertise and education to internal teams regarding payer trends, market developments, reimbursement changes, contract issues, and new payer products.
• Supports business development and strategic growth initiatives by advising on market reimbursement trends, charge strategies, fair market rates for new services, and ad hoc reporting needs.

QUALIFICATIONS

EDUCATION

• Bachelors degree required in business, technology or healthcare related field

EXPERIENCE

• Minimum of 3 years of experience in managed care environment

• 2+ years of negotiation or provider relations experience between providers and major commercial payors in markets in the U.S. and or experience in contract analysis for ASC services.

• Experience with ASC reimbursement methodologies.

• Experience working with clinically integrated networks, ACO’s, or other population health initiatives a plus.

• Experience working with payors and billing office staff to resolve payment discrepancies.

LICENSE(S)/CERTIFICATION(S)

• None.

KNOWLEDGE/SKILLS/ABILITIES

• Reasonable understanding of healthcare CPT coding and billing.
• Excellent quantitative and analytical skills, with attention to detail to ensure that modeling for negotiations is accurate.
• Moderate knowledge of Excel and/or ability to expand knowledge quickly.
• Solid understanding of payer contract reimbursement methodologies and application of payor policies on reimbursement expected under existing and future agreements.
• Strong writing skills and ability to communicate effectively in order to negotiate key terms of payor agreements.
• Understanding of healthcare industry trends in payor negotiations including contract language, product development trends, pay for performance programs, bundled payment programs, etc.
• Understanding of provider reimbursement methodologies from Medicare, and knowledge of how Medicare reimbursement is updated from time to time.
• Must be self-motivated and able to work independently.  Inquisitive nature and interest in sharing knowledge among team members.
• M…