Manager of Payer Relations, Contracting, & Credentialing

• Serve as the primary operational relationship owner for assigned health plans and payer partners.
• Develop and maintain strategic relationships with payer representatives, network leaders, contracting teams, and other key stakeholders.
• Establish a structured payer engagement cadence for Northpoint’s highest-impact payer relationships.
• Identify and escalate payer issues affecting patient access, reimbursement, authorization, claims payment, or operational performance.
• Partner with RCM and UR leadership to identify recurring payer behaviors and develop coordinated resolution strategies.
• Monitor payer and market developments that may create financial, operational, or access opportunities or risks.
• Support payer strategy for new markets, de novo facilities, acquisitions, new service lines, and geographic expansion.
• Maintain a payer opportunity and escalation pipeline, including contract opportunities, network gaps, reimbursement opportunities, and unresolved payer issues.
• Provide regular executive-level reporting regarding payer relationships, negotiations, network development, reimbursement opportunities, and material risks.

• Develop payer negotiation strategies in partnership with the EVP of RCM and Finance using reimbursement data, market intelligence, utilization trends, and organizational growth.
• Build an effective multi-state licensing and credentialing strategy and process that can scale nationally, coordinating between providers, medical boards, payers, and government agencies.
• Evaluate reimbursement performance and identify underperforming contract terms or rates requiring renegotiation.
• Develop and maintain payer contract summaries identifying reimbursement terms, authorization requirements, timely filing provisions, appeal requirements, exclusions, termination provisions, and other financially material terms.
• Partner with RCM analytics to quantify the financial impact of proposed rate changes and contract amendments.
• Identify opportunities to expand network participation and improve patient access across Northpoint markets.
• Ensure negotiated contract terms are operationalized across Admissions, UR, Clinical Operations, Billing, and other affected functions.

• Manages Northpoint’s full lifecycle of contract management, negotiations, rate increases, HCPCS/CPT requirements, and professional services
• Responsible for the overall management of all in-network and out-of-network contracting and negotiations for the organization and employed providers
• Coordinate with clinical operations, licensing agencies, insurance carriers, and other appropriate organizations to complete credentialing and recredentialing applications
• Maintain a database for licensing, contracting, and credentialing and continue to develop new processes and procedures, ensuring full utilization of systems and platforms
• Monitor entity-specific rules, policies, and procedures, ensuring compliance with accrediting organization and payer requirements; develop, recommend, and/or implement changes, revisions, and enhancements as appropriate to the current operating environment.
• Other duties as assigned.

• Collaborate with internal stakeholders such as the Director of RCM, Utilization Review Dept, Finance, and Charge master Systems/Analytics function to look at:
• Reimbursement by payer
• Authorization barriers
• Contractual adjustment trends
• Overpayment and Underpayments
• Out-of-network exposure
• Network adequacy/opportunities
• Rate performance
• Contract compliance
• Patient access barriers

• Bachelor’s degree in business administration, health management, or commensurate experience required
• Minimum of five (5) years of experience in managed care contracting and provider credentialing
• Minimum of three (3) years of hospital and/or payer negotiation and payer analysis experience
• Knowledge of fee-for-service and/or fee-for-value reimbursement methods, delegated credentialing workflows, and working knowledge of all major payers
• Strong at synthesizing information; easily distill easy-to-understand takeaways and next steps, diagnose problems, see patterns, and come up with targeted solutions
• Self-Starter; organize processes, improve workflows that already exist, and continuously strive for more efficiency
• Impeccable attention to detail; able to catch areas of opportunity in data or workflows quickly and document processes in a concise but thorough manner
• Must work well under pressure, able to focus on multiple priorities while maintaining focus, attention to detail and connecting all the dots
• Proficiency with Microsoft Office Suite

• Knowledge of behavioral health care HCPCS/CPT coding
• Business acumen and strong financial skills
• Able to maintain confidentiality of sensitive information
• Excellent communication skills: ability to communicate clearly and concisely, verbally and in writing
• Strong interpersonal skills to handle sensitive situations and confidential information
• Social ease and a demonstrated ability to build relationships with a variety of different people and personality types
• Ability to perform several tasks concurrently with ease and professionalism
• Ability to effectively prioritize workload in a fast-paced environment

This job description is not intended, and should not be construed, to be exhaustive lists of all responsibilities, skills, efforts or working conditions associated with this job. It is meant to be an accurate reflection of the principal job elements essential for making fair pay decisions about jobs.

Employees with potential access to protected health information must comply with all procedures and guidelines governed by HIPAA.

Northpoint is an Equal Opportunity Employer. Northpoint is an at-will employer. Employment may be terminated at any time by employee or the employer with or without notice.