Intern Healthcare Contracting Jobs (NOW HIRING)

Our client, a respected healthcare organization in the Greater Los Angeles region, is seeking an experienced Director of Managed Care Contracting to lead payor strategy, contract performance, and Revenue Integrity functions. This is a high‑impact leadership role responsible for advancing reimbursement outcomes, strengthening payor relationships, and driving financial sustainability across a complex acute‑care environment.

The Director of Managed Care Contracting provides strategic leadership for payor contracting, reimbursement performance, and Revenue Integrity operations. This leader oversees contract strategy, negotiations, renewals, implementation, analytics, and performance management across commercial, government, and value‑based arrangements. The role partners closely with executive leadership to evaluate payor proposals, reimbursement methodologies, operational requirements, and financial impact.

• Lead the full lifecycle of managed care contracting, including negotiation, renewal, execution, implementation, and administration of fee‑for‑service, capitation, value‑based, bundled service, and LOA arrangements.

• Evaluate payor proposals, reimbursement methodologies, contract terms, operational requirements, and financial impact.

• Direct contract language review and amendment to mitigate reimbursement exposure, authorization delays, policy changes, denial trends, underpayments, and compliance risks.

• Drive strategic direction for commercial, HMO/PPO, Medicare Advantage, Medi‑Cal/Medicaid, and other payor arrangements.

• Provide strategic leadership for Revenue Integrity functions, ensuring accurate reimbursement, compliance with contract terms, and effective underpayment resolution.

• Direct financial, operational, payor, and denial analytics to evaluate trends, revenue impact, claims activity, and opportunities for improvement.

• Lead disciplined contract performance reviews with recommendations for renewal, expansion, modification, termination, or escalation.

• Oversee executive dashboards that convert claims, denials, reimbursement trends, and payor behavior into actionable insights.

• Lead Denials Analytics across hospital and ambulatory settings, including appeals strategy, payor escalations, and Provider Relations coordination.

• Serve as senior escalation point for complex payor, contract, reimbursement, authorization, underpayment, and denial matters.

• Drive cross‑functional root‑cause analysis with Patient Access, UM, Case Management, CDI, HIM, ambulatory leadership, physicians, Finance, and Revenue Cycle.

• Advance organization‑wide denial prevention strategies aligned with contract terms, payor requirements, documentation standards, and billing workflows.

• Oversee operational implementation of managed care contracts, ensuring accurate rate setup, authorization alignment, payor policy communication, workflow readiness, and post‑implementation monitoring.

• Lead payor relations and cross‑functional engagement through governance meetings, joint operating sessions, issue‑resolution forums, and ongoing communication.

• Lead workflow modernization, automation, and technology‑enabled process improvement initiatives.

• Establish intake, triage, tracking, escalation, and accountability structures for payor issues, reimbursement disputes, authorization barriers, LOA requests, denial trends, and underpayments.

• Use continuous improvement methods, benchmarking, and analytics to drive measurable gains in managed care operations, Revenue Integrity, and contract performance.

• Serve as an expert on payor contract terms, reimbursement methodologies, payor policies, CMS coverage requirements, authorization processes, denial trends, managed care operations, and contract administration.

• Bachelor’s degree required (economics, business, finance, or healthcare preferred).

• Minimum 7 years of recent experience in hospital, medical, or healthcare insurance environments with direct payer contracting responsibilities in an acute‑care setting.

• Demonstrated expertise in negotiating and managing payer contracts, reimbursement methodologies, and payor analytics.

• Advanced Excel skills, including modeling and complex formulas.

• Experience with hospital billing systems and financial reporting tools.

• Strong communication, analytical, and problem‑solving skills.

• Master’s degree in healthcare economics, healthcare policy, or finance.

• 10+ years progressive hospital payer contracting experience.

• Prior experience supervising payer contracting or Revenue Integrity staff.

• High‑visibility leadership role influencing payor strategy and financial performance.

• Opportunity to shape contract outcomes, reimbursement strategy, and Revenue Integrity operations.

• Mission‑driven healthcare environment with strong executive support.

• Competitive compensation, bonus opportunity, and comprehensive benefits.