Contract Management & Revenue Integrity Specialist

Posted 19 Days Ago
Be an Early Applicant
Hiring Remotely in USA
Remote
3-5 Annually
Mid level
Healthtech • Information Technology
The Role
The Contract Management & Revenue Integrity Specialist manages payer contract negotiations, maintains fee schedules, resolves payment discrepancies, and ensures accurate reporting, directly impacting financial performance.
Summary Generated by Built In

Overview

Nira Medical is a national partnership of physician-led, patient-centered independent practices committed to driving the future of neurological care. Nira's mission is to enable clinicians to provide access to life-changing treatments so you can provide the best possible patient outcomes. Founded by neurologists who understand the unique challenges of the field, Nira Medical supports practices with cutting-edge technology, clinical research opportunities, and a collaborative and comprehensive care network dedicated to advancing the standard of care. As we enter the next phase of growth, our focus is on scaling our teams, services, and elevating the customer experience!

This is where you come in…

The Contract Management & Revenue Integrity Specialist has a strategic and operational role at the heart of Nira Medical’s financial performance. The ideal candidate brings deep knowledge of payer contracting, fee schedule structures, and revenue integrity principles, and thrives in a fast-paced environment where precision, cross functional collaboration, and proactive problem solving are essential. As our Contract Management & Revenue Integrity Specialist, you will serve as the single point of accountability for all things payer contracting and pricing. You will lead new contract negotiations, maintain and update allowable tables, and ensure our rates—across professional services, drugs, and ancillary—are accurately reflected in our systems. You will work closely with Revenue Cycle, Operations, Finance, and clinical teams to identify and resolve payment discrepancies, support payer projects, and deliver timely reporting that keeps leadership informed. This role is critical to protecting Nira Medical’s revenue and ensuring every dollar we’ve earned is captured correctly.

Here’s what you’ll be doing…

  • New Contracting & Negotiations: Lead all new payer contract negotiations, managing the end-to-end process from initial outreach through execution, ensuring terms align with organizational goals and market benchmarks.

  • Pricing & Rate Management: Establish and maintain fee schedules and contracted rates for professional services, drug/pharmacy, and ancillary services. Own rate-setting decisions in collaboration with Finance and clinical leadership.

  • Allowable Table Management: Maintain, update, and audit all payer allowable tables within Athena and any other relevant systems. Coordinate quarterly or monthly allowable schedule pulls based on payer requirements and internal cadence needs.

  • Mismatch & Variance Resolution: Identify, track, and resolve payment variances resulting from a mismatched allowable between contracted rates and actual payer remittances. Partner with billing and RCM teams to correct discrepancies and prevent recurrence.

  • Payer Relations & Collaboration: Serve as the primary point of contact for payer inquiries and projects related to contract pricing. Facilitate timely resolution of payer-initiated issues and proactively surface risks to leadership.

  • Reporting & Analytics: Generate and distribute regular reporting on contract performance, allowable schedules, out-of-network activity, and no-go status. Ensure leadership has the visibility needed for strategic decision-making.

  • Out-of-Network & No-Go Analysis: Conduct out-of-network analyses to evaluate financial exposure and inform contracting strategy. Maintain and distribute no-go reporting to flag payers or services where participation is not financially viable.

  • System Management (Athena & Beyond): Manage all updates within Athena related to contracts, allowable updates, payer configurations, and rate changes. Ensure system accuracy is maintained continuously, and changes are tested and validated upon implementation.

Here’s what we’re looking for…

  • Associate’s degree in healthcare administration, business, finance, or a related field; or equivalent relevant experience in payer contracting or revenue integrity

  • Minimum 3–5 years of experience in payer contracting, allowable management, or revenue integrity roles

  • Strong understanding of fee schedule structures, payer reimbursement methodologies, and contract terms across professional, drug/pharmacy, and ancillary service lines

  • Demonstrated experience managing allowable tables and rate configurations within Athena EHR or similar practice management systems

  • Proficiency in identifying and resolving payment variances and mismatch allowable

  • Experience with out-of-network analysis and no-go reporting frameworks

  • Excellent analytical and problem-solving skills with high attention to detail

  • Strong communication and negotiation skills; comfortable interfacing directly with payer representatives

  • Ability to manage multiple priorities and deadlines in a fast-paced, growth-oriented environment

  • Experience working in a multi-specialty, multi-location healthcare organization preferred

  • Athena EHR experience strongly preferred; experience with MSO structures a plus

Don’t feel like you have all the qualifications?

The description above indicates our current vision for the role. You could be a viable candidate even if you don’t fit everything we’ve described above and may also have important skills we haven’t thought of. If that’s you – even if you’re unsure – we encourage you to apply and help us get to know you!

Skills Required

  • Associate's degree in healthcare administration, business or finance
  • 3-5 years of experience in payer contracting or revenue integrity roles
  • Strong understanding of fee schedule structures and payer reimbursement methodologies
  • Experience managing allowable tables within Athena EHR
  • Proven ability to resolve payment variances
  • Excellent analytical and communication skills
  • Experience in multi-specialty healthcare organization preferred
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The Company
23 Employees

What We Do

Nira Medical is a partnership of independent practices focused on driving the future of neurological and rheumatic care delivery through a patient-centric, clinician-driven model empowered by technology. Our mission is to provide access to life changing treatments for those suffering from Alzheimer’s, MS, Parkinson’s, and similar disorders so that they can lead healthier, more fulfilling lives. If you’re excited about being on the cutting edge of these life-altering therapies, come join us

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