Manages relationships with health insurance payors and ensures compliance with all contractual agreements.
Locations (2)
New Mexico, United States
Texas, United States
Compensation
$70,000.00 - $80,000.00 plus bonus
Responsibilities
Serve as the primary liaison between the organization and managed care organizations, commercial payors, and governmental payors (e.g., Medicare, Medicaid).
Independently analyzes and interprets complex contractual and regulatory data to identify systemic compliance failures, developing and implementing strategic corrective action plans to recover maximum revenue.
Play a key role in the negotiation and renegotiation of payor contracts, determining acceptable reimbursement rates and terms within established parameters, and committing the organization to contract language that significantly impacts the company’s financial health and ease of operation.
Play a key role in the comprehensive implementation strategy for new payor agreements, ensuring alignment across Billing, Credentialing, and Clinical Services.
Maintain comprehensive, up-to-date documentation of all payor contracts, fee schedules, and correspondence in the designated file system.
Requirements
Bachelor's degree in Healthcare Administration, Business, or a related field
Lead, coach, and develop a high‑performing national and regional market access organization to drive payer coverage, reimbursement, and revenue growth.
Responsibilities
Lead, coach, develop, and inspire a high‑performing team of National Directors and Regional Market Access Managers
Establish clear performance expectations, KPIs, and accountability measures aligned to coverage, contracting, reimbursement, and access goals
Conduct regular business reviews, strategic account reviews, and performance coaching sessions
Develop succession plans and leadership pipelines for critical roles
Recruit, retain, and develop top talent while maintaining strong employee engagement
Requirements
Bachelor’s degree in Life Sciences, Business, Healthcare Administration, Public Health, or a related field
Develop and execute strategic payer account plans that expand coverage, contracting, and reimbursement for Baylor Genetics testing, with priority emphasis on WGS-first policies.
Responsibilities
Develop and execute strategic payer account plans that expand coverage, contracting, and reimbursement for Baylor Genetics testing, with priority emphasis on WGS-first policies.
Establish trusted, value-based partnerships with national and regional commercial health plans, Medicare Advantage organizations, Medicaid and Managed Medicaid plans, integrated delivery networks, and other risk-bearing entities.
Lead payer negotiations that translate clinical and economic value into favorable coverage policies, fee schedules, network agreements, value-based arrangements, and administrative pathways.
Create payer-specific value propositions that connect WGS-first testing to improved diagnostic yield, earlier clinical decision-making, reduced serial testing, fewer avoidable procedures, and lower total cost of care.
Partner with HEOR, Medical Affairs, Clinical Affairs, Product, Finance, Revenue Cycle, and Commercial teams to develop evidence strategies, budget-impact models, cost-offset analyses, real-world evidence, and payer-facing value dossiers.
The Manager, Denials and Managed Care Contracting will oversee and direct operations of the Managed Care Contracting, Denials & Underpayments, and Denials Management teams, developing strategies to optimize contracts, resolve denials, and improve financial outcomes.
Responsibilities
Develop and implement strategies to optimize managed care contracts
Resolve payer denials and underpayments
Engage payer leadership to resolve denials
Implement systemic improvements
Drive continuous improvement initiatives
Requirements
Bachelor's degree in Healthcare Administration, Business Administration, Finance, or related field
Payor Relations SpecialistNewCentria Autism · US+1 more