Payer Negotiation Specialist

JOB DESCRIPTION

ROMTech's Mission is to enable people to achieve superior health outcomes through engagement, data-driven insight, innovative technology, and exceptional service.

ROMTech is a medical technology company that has created and patented a revolutionary medical device and telemedical platform which delivers in-home rehabilitative care. Our disruptive technology has proven to yield faster recoveries and better outcomes with unmatched patient compliance. We began in orthopedics and have entered scale-up of our orthopedic business. We are now leveraging our core technology, infrastructure, and first mover position to enter cardiology, followed by other adjacent markets. Having created this new lane, we have a unique opportunity to serve as the global leader in the business, technology, and science of recovery, and to bring life-changing help to many millions of people.

Position Title: Payer Negotiation Specialist
Department: Market Access
Reports To: Director of Market Access
Location / Work Environment: Clearwater, FL (Onsite)
Worker Classification: W2 Employee
FLSA Status: Non-Exempt
Job Level: Standard

The Payer Negotiation Specialist is responsible for securing reimbursement pathways and facilitating access to ROMTech services by negotiating agreements with commercial and government health plans. This role serves as a primary liaison between payers, providers, revenue cycle teams, and patient access stakeholders to optimize reimbursement outcomes, support patient access, and minimize financial barriers to care. The position leverages expertise in payer policies, coverage criteria, single case agreements (SCAs), letters of agreement (LOAs), prior authorization requirements, and reimbursement methodologies to drive favorable payer outcomes and support organizational growth objectives.

• Negotiate single case agreements (SCAs), letters of agreement (LOAs), out-of-network agreements, and other reimbursement arrangements with health plans to secure patient access and reimbursement.
• Develop and implement payer engagement strategies designed to improve reimbursement outcomes and support business objectives.
• Communicate clinical, operational, and financial value propositions effectively during payer negotiations.
• Collaborate with providers, revenue cycle teams, patient access teams, and other internal stakeholders to align reimbursement strategies and communication efforts.
• Educate internal stakeholders regarding payer requirements, reimbursement processes, negotiation strategies, and SCA workflows.
• Serve as a subject matter expert on reimbursement pathways for non-covered, partially covered, or out-of-network services.
• Analyze health plan policies, medical necessity criteria, prior authorization requirements, and coverage guidelines to identify reimbursement opportunities and risks.
• Support appeals and escalation processes related to coverage determinations, medical necessity denials, and reimbursement disputes.
• Maintain thorough documentation of payer interactions, negotiations, agreements, and reimbursement outcomes.
• Monitor payer trends, policy updates, and market developments that may impact reimbursement strategies.
• Collaborate with cross-functional teams to develop recommendations that improve access, reimbursement, and operational effectiveness.
• Ensure compliance with applicable organizational policies, payer requirements, and regulatory standards.

• Participate in departmental meetings, training activities, and process improvement initiatives.
• Assist with reporting, data collection, and analysis related to payer performance and reimbursement outcomes.
• Support special projects related to market access, contracting, and reimbursement operations.
• Performs other related duties as assigned to support operational and business needs.

JOB QUALIFICATIONS

• Strong negotiation, persuasion, and influencing skills.
• Excellent verbal and written communication skills.
• Ability to communicate clinical and financial value effectively to payer representatives.
• Strong organizational, documentation, and case management abilities.
• Detail-oriented with the ability to manage multiple cases and priorities simultaneously.
• Ability to analyze payer policies, reimbursement requirements, and coverage criteria.
• Strong problem-solving and critical thinking skills.
• Proficiency with Microsoft Office applications and business systems.
• Ability to work effectively in a fast-paced, high-stakes patient access environment.
• Ability to collaborate successfully across cross-functional teams.

• Familiarity with healthcare reimbursement methodologies and revenue cycle optimization strategies.
• Knowledge of CPT, HCPCS, and related coding systems.
• Experience presenting reimbursement strategies to executive or clinical stakeholders.
• Experience interacting with payer medical directors, utilization management teams, or contracting departments.

• 3 to 7 years of experience in healthcare reimbursement, payer relations, managed care contracting, market access, or revenue cycle operations.
• Demonstrated experience negotiating with health plans.
• Experience supporting prior authorization, medical necessity review, appeals, or reimbursement-related processes.
• Working knowledge of commercial insurance, Medicare, and Medicaid reimbursement structures.

• Experience negotiating single case agreements (SCAs), letters of agreement (LOAs), or out-of-network reimbursement arrangements.
• Experience with specialty therapies, medical devices, durable medical equipment, or high-cost healthcare services.
• Experience working with providers, health systems, or payer organizations.
• Experience supporting market access initiatives within a healthcare or medical technology environment.

• None.

• Bachelor's degree in Business Administration, Healthcare Administration, Finance, Public Health, Health Policy, or a related field.

• None.

• Certified Revenue Cycle Representative (CRCR) or similar healthcare reimbursement certification.
• Certified Professional Coder (CPC) or comparable coding-related certification.
• Other market access, payer contracting, reimbursement, or healthcare finance certifications.

Physical Demands and Working Conditions

The following describes the physical demands and work environment characteristics required to perform the essential functions of this position. These requirements are representative of those an employee may encounter while performing the job and are not intended to be an exhaustive list. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the role.

• Ability to sit at a computer terminal for an extended period. 

• Moderate noise (i.e., phone calls, online meetings, computer audio) 

• While performing the duties of this job, the employee may be regularly required to stand, sit, talk, hear, reach, stoop, kneel, and use hands and fingers to operate a computer, telephone, and keyboard. 

• Specific vision abilities required by this job include close vision requirements due to computer work. 

• Regular, predictable attendance is required. 

• Must be able to communicate clearly and professionally in both verbal and written formats.

• Must be able to engage in active listening and express ideas effectively in person, by phone, and via virtual meetings.

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Reasonable accommodation requests must be made in writing by emailing [email protected].