Ovation Healthcare · 1 month ago
Senior Consultant, Payer Relations
Tennessee, United States
Full-time
Hybrid
Mid, Senior Level
3+ years expOvation Healthcare is a company dedicated to strengthening independent community healthcare. The Senior Consultant of Payer Relations is responsible for managing client relationships with hospitals, serving as the primary liaison between the hospitals and managed care payers, while also providing support in contract negotiations and educational programs.
AdviceBusiness DevelopmentHealth CareManagement Consulting
Responsibilities
Responsible for the engagement life cycle and its relationship to project activities while producing client ready deliverables
Leads negotiation of provider and payer ensuring alignment with organizational goals and financial targets
Leads complex contract initiatives, including new provider network, negotiation cycles, or service expansions
Review and analyze data for contract administration – evaluate the profitability of contract renewals/existing contracts
Work with Payer Relations Team to establish a work plan, set priorities, organize tasks, resource needs and recommend appropriate methodologies, tools and resources to optimize project profitability
Develop and maintain resource materials/tools for clarification of contracts (language templates)
Responsible for managing client expectations in line with budget and project objectives
Assist with updates to the Contract Tracker, Contract matrices, Client Agendas and other documents used to communicate project status and updates with the clients
Ensure annual escalators from payers are requested, validated, updated in the Contract Matrix, and shared with hospital staff
Qualification
Required
Proven track record of achieving goals and objectives as it relates to managed care contracting
Intermediate level of analytical skills and experience
Strong communication skills: ability to interact with multiple levels of clients (ie hospital/physicians/payor plans/corporate staff)
Proficient in Microsoft applications- Word/Access/Excel
Intermediate level Excel experience (pivot tables, V-lookup's, etc)
Critical thinking and problem-solving abilities
Understanding of Medicare/Medicaid government contracting, reimbursement, and regulations
Healthcare experience required
3-5 Managed Care and/or Payer Relations experience required
Experience working in a managed care environment for a healthcare delivery system (Professional or Facility managed care experience in this environment is sufficient)
Possess strong negotiating skills with a successful track record negotiating contracts with individuals, groups, complex systems
Track contract performance post contract execution and recommend adjustments as needed (i.e, chargemaster increases, etc)
Maintain accurate documentation of any negotiations, contract versions, and final agreements
Prepare negotiation, assist with financial models, complete analysis and strategy options and recommendations for leadership
Develop negotiation strategies based on trends, regulatory requirements/guidelines, and competitive markets
Conduct detailed claims analysis to assess financial impact of proposed contract terms
Analyze contract terms, reimbursement methodologies for all negotiations
Implement best practices and process improvements for contract lifecycle management
Possess a keen understanding of managed care contracting and related initiatives, as well as the underlying systems that support those initiatives
Identify and analyze user requirements, procedures, and problems to improve existing reimbursement and identify opportunities for improvement
Perform detailed analysis on multiple projects, recommend potential business solutions and ensure successful implementations
Monitor market research on reimbursement benchmarks, network adequacy, and industry trends. Develop, share, and incorporate organizational best practices into business applications
Build and maintain strong relationships with providers, health systems, payers, and other partners
Prepare high level reports summarizing negotiation status, outcomes, financial impact and strategic recommendations
Provide strategic guidance to clients and/or leadership on trends such as value-based care, telehealth, and alternative payment models
Manage day to day client relationships while managing client expectations in line with budget and project objectives
Assist Payer Relations Team in managing quality of the work product and interact directly with mid-level client contacts and above on engagement issues
Ability to deliver client reports within 30 days of a client meeting
Up to 50% travel
Preferred
BS/BA preferred in a related field or relevant experience is desired
Company
Ovation Healthcare
Ovation Healthcare is a business consulting firm that offers revenue cycle, clinical resourcing, and advisory management services.
1001-5000 employees
Funding
Current Stage
Late StageTotal Funding
unknown2021-06-01Acquired
Leadership Team
Timothy J. Ryan
CFO
Recent News
2025-10-02
Mergers & Acquisitions
2025-07-14
Company data provided by crunchbase