Payer Contracting Mgr

Job Description Location: Chicago, Illinois Business Unit: Rush Medical Center Hospital: Rush University Medical Center Department: Rush Health Contracting Work Type: Full Time (Total FTE between 0.9 and 1.0) Remote Shift: Shift 1 Work Schedule: 8 Hr (7:00:00 AM - 3:00:00 PM) Rush offers exceptional rewards and benefits learn more at our Rush benefits page ( Pay Range: $45.59 - $66.16 per hour Rush salaries are determined by many factors including, but not limited to, education, job-related experience and skills, as well as internal equity and industry specific market data. The pay range for each role reflects Rushu2019s anticipated wage or salary reasonably expected to be offered for the position. Offers may vary depending on the circumstances of each case. Summary: Rush Health is a clinically integrated network of physicians and hospitals working together to improve health through high quality, efficient health services covering the spectrum of patient care from wellness, prevention and health promotion, to disease management and complex care management. Our network includes Rush University Medical Center, Rush Oak Park Hospital, Rush Copley Medical Center, Riverside Medical Center and over 1900 professional providers. All hiring is done through Rush University Medical Center Human Resources. The Payer Contracting Manager is responsible for developing and maintaining relationships with third party payers including but not limited to Managed Care Commercial payers, Medicare Advantage payers and Medicaid payers and negotiating managed care agreements both fee-for-service (FFS) and value based care (VBC) with these third party payers on behalf of Rush Health Participating Hospitals and Physicians (Members). These negotiations shall be under the direction of the Directors of FFS Payer Contracting and VBC Payer Contracting. This responsibility also includes management of referral contracts with other physician organizations. This position shall also assist in Member education regarding payer agreements and in monitoring and enforcing payer compliance with contract terms. This position is pivotal to capturing and retaining business for our Members and growing and maximizing financial performance. Exemplifies the Rush mission, vision and values and acts in accordance with Rush policies and procedures. Other information: Required Job Qualifications: u2022Bachelor's Degree u2022At least five (5) yearsu2019 experience in a managed care environment with direct payer contracting experience. u2022Experience in multi-facility health system, large academic medical center or insurer environment. u2022Strong financial knowledge base related to all managed care reimbursement methodologies including the various fee-for-service structures and risk based structures such as capitation, shared savings and global payments. u2022Specific and thorough understanding of physician and hospital coding, claim forms, payer EOBs and reimbursement methodologies. u2022Knowledge base of population health management activities and value based care delivery models Strong written and verbal communication skills. u2022Strong analytical and problem solving skills. u2022Strong attention to detail and well organized. u2022Adapts well to rapid change and multiple, demanding priorities. u2022Excellent time and project management skills. u2022Must be able to work on multiple projects simultaneously. u2022Ability to network internally and externally to build relationships, facilitate discussion and resolution. u2022Microsoft Office Suite advanced proficiency, particularly MS Excel. Preferred Job Qualifications: u2022Master's degree in Health Care Administration or Business. u2022Understanding of contract law highly desirable. u2022Experience with governmental programs related to Medicare, Medicaid and Medicare Advantage highly desirable. Responsibilities: u2022 Negotiate and maintain fee-for-service (FFS) contracts with third party payers as assigned by the Director, FFS Payer Contracting. u2022 Assist in the development and negotiation of value-based care (VBC) risk contracts with third party payers as assigned by the Director, Value Based Payer Contracting. u2022 Negotiate, analyze and model current, proposed, and final FFS pricing terms for hospitals and physicians in accordance with Rush Health pricing standards. u2022 Under the direction of Director, Value Based Payer Contracting, assist in negotiation of VBC financial risk terms working in conjunction with Analytics and actuary, when needed, to develop financial risk models to analyze payer VBC proposals including ACO, shared savings/shared risk, capitation, global bundled pricing and % of premium contracts. u2022 Under the direction of Directors Contracting, evaluate and initiate new FFS and VBC contract opportunities. u2022 Negotiate FFS contract language in accordance with Rush Health language standards. u2022 Under the direction of Director, Value Based Payer Contracting, assist in negotiation of VBC contract language and performance terms in consultation with Rush Health business and support departments (Clinical, Analytics, HIT, Payer Relations, Legal, Finance). u2022 This includes legal, compliance, quality measures, reporting and data exchange requirements. Coordination through VBC Workgroup. u2022 Monitor and analyze performance of third party payer agreements including profitability, volume, strategic initiatives and payer compliance issues. u2022 Develop and maintain relationships with third party payers. u2022 Establish and maintain a system of reviewing and assessing changes in the Federal and or State regulations in regards to Managed Care contracts. u2022 Achieve and maintain a full understanding of Medicare and or Medicaid pricing reimbursement and structure for both physicians and hospitals. u2022 Work closely with Directors, Contracting to develop and monitor contract negotiation schedules, timelines and annual pricing renewals. u2022 Assist in the development and implementation of an annual strategic plan for third party payer contracting, including the continued development of VBC opportunities and implementation of pricing strategies and contract language standards. u2022 Assist Director, Value Based Payer Contracting in coordination and management of VBC program initiatives and contract terms with governmental payers including CMS and programs such as MSSP, BPCI. u2022 Manage negotiations for all

Created: 2026-03-19