Manager of Payer Relations, Contracting, & Credentialing As a key member of the Northpoint team, reporting to the Executive Vice President of Revenue Cycle Management, the Manager of Payer Relations, Contracting & Credentialing is responsible for advancing Northpoint's payer strategy through effective payer relationship management, contract negotiation and performance, network development, and credentialing oversight across the organization's markets. This position serves as a key organizational liaison with commercial and government payers and is responsible for developing and maintaining productive payer relationships, identifying opportunities to strengthen network participation and reimbursement, resolving payer-related barriers, and supporting Northpoint's continued expansion into existing and new markets. The Manager leads the full lifecycle of payer contracting, including contract evaluation, negotiation, rate strategy, amendments, reimbursement terms, and operational implementation of contractual requirements. The position partners closely with Revenue Cycle, Utilization Review, Finance, Clinical Operations, Business Development, and Executive Leadership to evaluate payer performance, identify emerging risks and opportunities, and ensure payer strategies support patient access, revenue integrity, and organizational growth. The position also maintains leadership oversight of Northpoint's credentialing, recredentialing, enrollment, licensing, and related regulatory processes, ensuring facilities and providers remain appropriately credentialed and compliant with payer, state, federal, CAQH, Medicare, and Medicaid requirements. As Northpoint continues to expand, this role is expected to build scalable payer relations, contracting, and credentialing infrastructure capable of supporting new markets, service lines, acquisitions, and de novo growth.
Essential Responsibilities and Duties Include:- Serve as the primary operational relationship owner for assigned health plans and payer partners.
- Develop and maintain strategic relationships with payer representatives, network leaders, contracting teams, and other key stakeholders.
- Establish a structured payer engagement cadence for Northpoint's highest-impact payer relationships.
- Identify and escalate payer issues affecting patient access, reimbursement, authorization, claims payment, or operational performance.
- Partner with RCM and UR leadership to identify recurring payer behaviors and develop coordinated resolution strategies.
- Monitor payer and market developments that may create financial, operational, or access opportunities or risks.
- Support payer strategy for new markets, de novo facilities, acquisitions, new service lines, and geographic expansion.
- Maintain a payer opportunity and escalation pipeline, including contract opportunities, network gaps, reimbursement opportunities, and unresolved payer issues.
- Provide regular executive-level reporting regarding payer relationships, negotiations, network development, reimbursement opportunities, and material risks.
- Contracting & Reimbursement Strategy:
- Develop payer negotiation strategies in partnership with the EVP of RCM and Finance using reimbursement data, market intelligence, utilization trends, and organizational growth.
- Build an effective multi-state licensing and credentialing strategy and process that can scale nationally, coordinating between providers, medical boards, payers, and government agencies.
- Evaluate reimbursement performance and identify underperforming contract terms or rates requiring renegotiation.
- Develop and maintain payer contract summaries identifying reimbursement terms, authorization requirements, timely filing provisions, appeal requirements, exclusions, termination provisions, and other financially material terms.
- Partner with RCM analytics to quantify the financial impact of proposed rate changes and contract amendments.
- Identify opportunities to expand network participation and improve patient access across Northpoint markets.
- Ensure negotiated contract terms are operationalized across Admissions, UR, Clinical Operations, Billing, and other affected functions.
- Provider Credentialing, Enrollment & Compliance:
- Manages Northpoint's full lifecycle of contract management, negotiations, rate increases, HCPCS/CPT requirements, and professional services
- Responsible for the overall management of all in-network and out-of-network contracting and negotiations for the organization and employed providers
- Coordinate with clinical operations, licensing agencies, insurance carriers, and other appropriate organizations to complete credentialing and recredentialing applications
- Maintain a database for licensing, contracting, and credentialing and continue to develop new processes and procedures, ensuring full utilization of systems and platforms
- Monitor entity-specific rules, policies, and procedures, ensuring compliance with accrediting organization and payer requirements; develop, recommend, and/or implement changes, revisions, and enhancements as appropriate to the current operating environment.
- Other duties as assigned.
- Payer Performance & Revenue Intelligence:
- Collaborate with internal stakeholders such as the Director of RCM, Utilization Review Dept, Finance, and Charge master Systems/Analytics function to look at:
- Reimbursement by payer
- Authorization barriers
- Contractual adjustment trends
- Overpayment and Underpayments
- Out-of-network exposure
- Network adequacy/opportunities
- Rate performance
- Contract compliance
- Patient access barriers
- Qualifications/Requirements for Position:
- Bachelor's degree in business administration, health management, or commensurate experience required
- Minimum of five (5) years of experience in managed care contracting and provider credentialing
- Minimum of three (3) years of hospital and/or payer negotiation and payer analysis experience
- Knowledge of fee-for-service and/or fee-for-value reimbursement methods, delegated credentialing workflows, and working knowledge of all major payers
- Strong at synthesizing information; easily distill easy-to-understand takeaways and next steps, diagnose problems, see patterns, and come up with targeted solutions
- Self-Starter; organize processes, improve workflows that already exist, and continuously strive for more efficiency
- Impeccable attention to detail; able to catch areas of opportunity in data or workflows quickly and document processes in a concise but thorough manner
- Must work well under pressure, able to focus on multiple priorities while maintaining focus, attention to detail and connecting all the dots
- Proficiency with Microsoft Office Suite
Preferred Knowledge and Skills:- Knowledge of behavioral health care HCPCS/CPT coding
- Business acumen and strong financial skills
- Able to maintain confidentiality of sensitive information
- Excellent communication skills: ability to communicate clearly and concisely, verbally and in writing
- Strong interpersonal skills to handle sensitive situations and confidential information
- Social ease and a demonstrated ability to build relationships with a variety of different people and personality types
- Ability to perform several tasks concurrently with ease and professionalism
- Ability to effectively prioritize workload in a fast-paced environment
- Full-Time Benefits Include:
- Subsidized Health Insurance Coverage for Employee, Spouse, & Dependent(s)100% Employer Paid Basic Life Insurance equal to 1x annual salary, up to $100,000100% Employer Paid Employee Assistance Program
Voluntary Dental, Vision, Short-Term Disability, Supplemental Life & AD&D, Critical Illness, Accident, and Hospital Indemnity Insurance.
Pre-tax Savings Accounts for all IRS-allowable medical and dependent care expenses
Generous Paid Time Off plan
Employee Referral Bonuses 401K Retirement Plan & Employer Match
