[Hiring] Senior Contracting Specialist @Ventra Health

Role Description

We are seeking a Senior Contracting Specialist to join our Payer Strategy & Contracting team, reporting to the Manager, Payor Strategy & Contracting. This is a senior individual contributor role for a candidate with hands-on payer contracting experience — gained either on the payer side (health plan network management or contracting) or the provider side (medical group, IPA, hospital, or ancillary provider contracting). The Senior Contracting Specialist independently manages contract negotiation, analysis, and documentation for an assigned portfolio of provider clients and facilities on behalf of our clients, operating with a sense of urgency and comfort under pressure. This is a client-facing role responsible for resolving escalated client concerns related to payer contracts and reimbursement, while also serving as a resource to Contracting Specialists on the team.

Essential Functions and Tasks

• Payer Strategy & Negotiation
  • Conduct contract negotiation discussions on behalf of clients with payers across fee-for-service (FFS) and value-based contract models, escalating high-complexity or high-value negotiations to the Manager as needed.
  • Develop negotiation materials including rate benchmarking, reimbursement trend analysis, and financial impact summaries.
  • Identify rate optimization opportunities within the assigned book of business and recommend contract structures that support improved rates.
  • Review and interpret payer contract language across payer, medical group/IPA, and hospital/ancillary contexts.
  • Apply working knowledge of managed care frameworks, reimbursement methodologies, and applicable healthcare regulations to contract review and negotiation.
  • Maintain accurate, up-to-date documentation of payer contracts, amendments, fee schedules, and client communication logs.
  • Serve as a subject-matter resource and informal mentor to Contracting Specialists on contract interpretation and negotiation best practices.
• Deal Execution & Financial Alignment
  • Partner with Revenue Cycle, AR, and Billing teams to ensure contract terms are accurately operationalized within systems and workflows.
  • Support translation of clinical program details — including virtual care, hospital-based professional services, and multi-site models — into reimbursable contract terms.
  • Identify and escalate discrepancies between contracted terms and actual payer performance.
  • Assist in preparing contract terms for client and client’s legal counsel for review.
• Cross-Functional Collaboration
  • Act as a key liaison between Payer Strategy & Contracting and internal stakeholders — including Legal, Finance, Service Delivery, and Client Success — on contract-related matters.
  • Provide clear, timely updates to the Manager on contract status, risks, and negotiation progress.
  • Support audit readiness and compliance with payer requirements, including documentation and contract interpretation guidance.
• Client & Payer Relationship Management
  • Serve as a client-facing point of contact for assigned accounts, fielding and resolving escalated client concerns related to payer contracts, reimbursement, and payer performance.
  • Maintain working relationships with assigned payer contacts and represent the organization in routine payer meetings and operational reviews.
  • Participate in client meetings or calls to support strategic initiatives and provide status updates on contracting activity.
  • Track payer reimbursement trends, policy changes, and competitive dynamics relevant to the assigned book of business.
  • Escalate emerging payer or client risks and opportunities to the Manager.
• Analytics & Performance Monitoring
  • Analyze payer performance, denial trends, and payment variances within the assigned portfolio to identify and act on improvement opportunities.
  • Support development of payer scorecards and KPIs to evaluate contract effectiveness.
  • Contribute to financial models supporting contracting, re-contracting, and new market entry decisions.

Qualifications

• 5+ years of experience in managed care/payer contracting, gained on either the payer side (health plan contracting or network management) or the provider side (medical group, IPA, hospital, or ancillary provider contracting).
• Demonstrated experience negotiating payer agreements and interpreting contract language.
• Working knowledge of reimbursement methodologies, including FFS, RBRVS, capitation, and value-based arrangements.
• Bachelor's degree in Healthcare Administration, Business, Finance, or a related field, or equivalent experience.

Preferred

• Experience on both the payer and provider sides of contracting.
• Familiarity with Medicaid, Medicare Advantage, and/or pediatric reimbursement structures.
• Experience mentoring or guiding junior contracting staff.
• Experience collaborating with offshore or distributed team members.
• AAHAM and/or HFMA certification.

Knowledge, Skills, and Abilities

• Ability to operate under pressure and manage multiple concurrent negotiations with a strong sense of urgency.
• Demonstrated experience operating in a client-facing capacity, with the ability to professionally manage and resolve escalated client concerns.
• Proficiency with Excel, contract management systems (e.g., Ironclad or comparable platforms), and project management tools.
• Working proficiency with company-approved AI tools (Claude, Microsoft Copilot) to support contract analysis, drafting, and workflow efficiency.
• Strong written and verbal communication skills, with the ability to represent the organization credibly in payer-facing conversations.
• High attention to detail in contract review, interpretation, and documentation.

Compensation

Base Compensation will be based on various factors unique to each candidate including geographic location, skill set, experience, qualifications, and other job-related reasons. This position is also eligible for a discretionary incentive bonus in accordance with company policies.