Payer Contracting Specialist - Naven Health
Naven Health, Austin, TX, United States
Payer Contracting Specialist / Associate Manager
Naven Health is a nationwide home infusion nursing network and clinical platform focused on delivering specialized, truly exceptional infusion care. With over 1,600 team members, including over 1,500 nurses, we are a company aligned to the values of the nurses at our center to provide an exceptional infusion experience, everywhere. Naven Health delivers home infusion services for a broad range of specialized therapies, as well as clinical trial services and special programs for pharmaceutical manufacturers. Joining the Naven Health team means being a part of a dynamic and growing organization that is dedicated to our customers, our teammates, and the patients we serve. The Payer Contracting Specialist / Associate Manager supports and advances Naven Health's payer strategy through a combination of payer analytics, contracting execution, and direct negotiation support. This role is responsible for conducting in-depth research on reimbursement methodologies, payer policies and government requirements, analyzing contract performance, preparing negotiation strategies, and supporting or independently managing portions of payer negotiations. The role operates with increasing autonomy, serving as a key contributor to contract development, payer relationship management, and strategic contracting recommendations. Job Responsibilities
Leads analytical assessments of existing payer contracts. Develops negotiation packets, rate models, and payer performance summaries. Supports or independently manages payer negotiations. Initiate and lead meetings with health plans and corporate teams to review payer agreement performance data and scorecards. Informs leadership of contract risks for payer contracts. Recommends course of action to reduce/minimize risk to the organization. Conducts research on reimbursement methodologies. Maintains payer prioritization models. Serves as a point of contact for assigned payers. Educates sales representatives on the changes to or addition of payer contracts to support growth of assigned markets. Identifies and assesses impact of potential changes in the industry or changes related to new state or federal legislation. Maintains successful working relationships with internal departments such as Operations, Legal, Sales, and any other departments that are involved with or impacted by payer contracts. Develops executive-ready reports and presentations. Supervisory Responsibilities
Does this position have supervisory responsibilities? No Basic Qualifications
Bachelor's degree required 35 years of experience in payer contracting, managed care, network strategy, or reimbursement roles within a healthcare organization Working knowledge of alternative payment methodologies (PMPM, case rates, episodic payments) Strong analytical and research skills Strong written, verbal communication and presentation skills Preferred Qualifications
Experience negotiating alternative payment models (APM) Experience with value-based contracting, shared savings arrangements, or risk-based models Medicaid managed care contracting experience Familiarity with financial modeling for payer ROI and total cost of care impact Travel Requirements
Up to 1015% travel anticipated. This job description is to be used as a guide for accomplishing Company and department objectives, and only covers the primary functions and responsibilities of the position. It is in no way to be construed as an all-encompassing list of duties. Due to state pay transparency laws, the full range for the position is below: Salary to be determined by the applicant's education, experience, knowledge, skills, and abilities, as well as internal equity and alignment with market data. Pay Range is $59,550.70-$99,273.67 Benefits: -Medical, Dental, & Vision Insurance -Paid Time off -Bonding Time Off -401K Retirement Savings Plan with Company Match -HSA Company Match -Flexible Spending Accounts -Tuition Reimbursement -myFlexPay -Family Support -Mental Health Services -Company Paid Life Insurance -Award/Recognition Programs Naven Health subscribes to a policy of equal employment opportunity, making employment available without regard to race, color, religion, national origin, citizenship status according to the Immigration Reform and Control Act of 1986, sex, sexual orientation, gender identity, age, disability, veteran status, or genetic information.
Naven Health is a nationwide home infusion nursing network and clinical platform focused on delivering specialized, truly exceptional infusion care. With over 1,600 team members, including over 1,500 nurses, we are a company aligned to the values of the nurses at our center to provide an exceptional infusion experience, everywhere. Naven Health delivers home infusion services for a broad range of specialized therapies, as well as clinical trial services and special programs for pharmaceutical manufacturers. Joining the Naven Health team means being a part of a dynamic and growing organization that is dedicated to our customers, our teammates, and the patients we serve. The Payer Contracting Specialist / Associate Manager supports and advances Naven Health's payer strategy through a combination of payer analytics, contracting execution, and direct negotiation support. This role is responsible for conducting in-depth research on reimbursement methodologies, payer policies and government requirements, analyzing contract performance, preparing negotiation strategies, and supporting or independently managing portions of payer negotiations. The role operates with increasing autonomy, serving as a key contributor to contract development, payer relationship management, and strategic contracting recommendations. Job Responsibilities
Leads analytical assessments of existing payer contracts. Develops negotiation packets, rate models, and payer performance summaries. Supports or independently manages payer negotiations. Initiate and lead meetings with health plans and corporate teams to review payer agreement performance data and scorecards. Informs leadership of contract risks for payer contracts. Recommends course of action to reduce/minimize risk to the organization. Conducts research on reimbursement methodologies. Maintains payer prioritization models. Serves as a point of contact for assigned payers. Educates sales representatives on the changes to or addition of payer contracts to support growth of assigned markets. Identifies and assesses impact of potential changes in the industry or changes related to new state or federal legislation. Maintains successful working relationships with internal departments such as Operations, Legal, Sales, and any other departments that are involved with or impacted by payer contracts. Develops executive-ready reports and presentations. Supervisory Responsibilities
Does this position have supervisory responsibilities? No Basic Qualifications
Bachelor's degree required 35 years of experience in payer contracting, managed care, network strategy, or reimbursement roles within a healthcare organization Working knowledge of alternative payment methodologies (PMPM, case rates, episodic payments) Strong analytical and research skills Strong written, verbal communication and presentation skills Preferred Qualifications
Experience negotiating alternative payment models (APM) Experience with value-based contracting, shared savings arrangements, or risk-based models Medicaid managed care contracting experience Familiarity with financial modeling for payer ROI and total cost of care impact Travel Requirements
Up to 1015% travel anticipated. This job description is to be used as a guide for accomplishing Company and department objectives, and only covers the primary functions and responsibilities of the position. It is in no way to be construed as an all-encompassing list of duties. Due to state pay transparency laws, the full range for the position is below: Salary to be determined by the applicant's education, experience, knowledge, skills, and abilities, as well as internal equity and alignment with market data. Pay Range is $59,550.70-$99,273.67 Benefits: -Medical, Dental, & Vision Insurance -Paid Time off -Bonding Time Off -401K Retirement Savings Plan with Company Match -HSA Company Match -Flexible Spending Accounts -Tuition Reimbursement -myFlexPay -Family Support -Mental Health Services -Company Paid Life Insurance -Award/Recognition Programs Naven Health subscribes to a policy of equal employment opportunity, making employment available without regard to race, color, religion, national origin, citizenship status according to the Immigration Reform and Control Act of 1986, sex, sexual orientation, gender identity, age, disability, veteran status, or genetic information.