Payor Contract Specialist

Payor Contract Specialist

COMPANY DESCRIPTION

Unio Health Partners (UHP) is a highly differentiated physician practice management platform with the goal of transforming care delivery across the Western United States. UHP partners with leading physician practices, creating a cohesive, quality-oriented clinical culture and facilitating best practice sharing across the platform. Our affiliated practices gain access to a broader suite of services, providing a meaningful benefit to both physicians and patients. UHP's best-in-class clinical program covers three sub-specialties (urology, gastroenterology, and radiation oncology) and offers numerous ancillary services, including pathology lab, in-office dispensing, and chronic care management. We are led by a highly accomplished management team and provide a full suite of management services to its affiliated practices. UHP is currently affiliated with 185 clinicians operating out of 62 locations across Southern, Central, and Northern California.

POSITION SUMMARY

The Payor Contract Specialist independently supports and enhances the organization’s managed care contracting strategy through advanced analysis, interpretation, and optimization of payor agreements.

This role is responsible for reviewing and interpreting payor agreements, analyzing reimbursement methodologies and contract performance, researching contract-related issues, and providing the analysis and recommendations needed to support contracting decisions.

The Specialist works closely with Payor Contracting, Revenue Cycle Management (RCM), Finance, Patient Access, and Operations to ensure contract terms are understood, accurately implemented, and performing as intended.

What you will be doing

• Review and interpret healthcare payor contracts, amendments, fee schedules, reimbursement methodologies, and carve-outs.
• Analyzes contract performance, reimbursement trends, and variances, and develops recommendations to optimize contract outcomes
• Provides guidance and recommendations to leadership on contract terms, reimbursement methodologies, and financial implications
• Exercises independent judgment in researching, analyzing, and resolving complex reimbursement discrepancies and contract-related issues
• Leads root cause analysis of reimbursement variances and determines appropriate resolution strategies
• Interprets contract provisions and determines application to operational and billing scenarios
• Partner with RCM, Finance, Patient Access, and Operations to ensure contract terms are accurately implemented and operationalized.
• Advises stakeholders and leadership on contract interpretation, reimbursement strategy, and issue resolution
• Communicates findings, trends, and recommendations to inform leadership decision-making
• Identifies and leads initiatives to improve contract performance, reimbursement tracking, and issue resolution processes
• Develops and implements process improvements that enhance operational efficiency and revenue outcomes
• Supports development of tools, reporting, and dashboards to monitor contract performance
• Oversees the integrity and accuracy of contract data, including key terms, rates, and effective dates
• Ensures contract terms are appropriately operationalized across systems and workflows
• Provides guidance on contract-related system configuration and alignment
• May support provider credentialing and payor onboarding activities related to contract execution and network participation

What you will bring to the team

• Bachelor’s degree in Business, Healthcare Administration, Finance, or related field (preferred)
• 3+ years of direct experience in healthcare payor contracting, managed care contracting, provider contracting, or a closely related contracting role.
• Strong understanding of healthcare reimbursement methodologies, fee schedules, and commercial, Medicare, and Medi-Cal payor structures.
• Ability to interpret contracts and translate terms into financial and operational impact
• Strong written and verbal communication skills, with the ability to present complex information clearly, influence stakeholders, and provide recommendations to leadership
• Working knowledge of Medicare, Medi-Cal, and commercial payor structures and enrollment processes

Who Will Be Successful in This Role

• This position is ideal for someone who has worked directly with healthcare payor/provider contracts and understands how contract terms translate into reimbursement and day-to-day operations.
• The ideal candidate will have direct experience working with healthcare payor/provider contracts and a strong understanding of provider reimbursement. This is a contracting-focused position and is not primarily a credentialing, legal, or general financial analyst role.

What we can offer you

• Competitive Salary and Health Benefits (Medical, Dental, Vision)
• Generous time off (start accruing on your first day - no waiting period)
• Paid Holidays
• 401(k)
• Company Discounts
• Collaborative work environment - we want our employees to have a say in how we run our office
• Employee Recognition

Compensation is depending on a number of factors including a candidate’s qualifications, skills, competencies, or experience that may fall outside of the range shown