Manager – Payer Strategy, Revenue Intelligence

🌍 Remote, USA 💹 Full-time 🕐 Posted Recently

Job Description

Execute hands-on payer contracting and credentialing support for behavioral health and substance use disorder providers, including research, sequencing, payer selection, and application strategy by state and level of care.
Conduct detailed billing compliance and reimbursement reviews to validate that services, codes, modifiers, units, and rates align with behavioral health payer rules, Medicaid state plans, and managed care organization requirements.
Serve as an internal subject-matter expert on behavioral health reimbursement, including PHP, IOP, OP, MAT, and related services across Medicaid and commercial payers.
Perform deep payer and regulatory research, including Medicaid state plans, managed care contracts, utilization guidelines, and commercial payer manuals, translating findings into clear internal guidance and client-ready analysis.
Develop payer-focused reports, reimbursement analyses, and BI outputs that reflect actual payer methodologies rather than assumed or modeled rates.
Build and maintain internal payer intelligence tools, including reimbursement matrices, payer summaries, credentialing trackers, and contracting reference materials specific to behavioral health.
Support payer relations and audit preparedness by developing documentation, financial analysis, and regulatory interpretation to support payer inquiries, audits, and contract discussions.
Partner with leadership on payer mix strategy, revenue integrity risk identification, and market entry analysis for behavioral health programs.

Demonstrated experience in behavioral health payer contracting, credentialing, reimbursement analysis, billing compliance, or payer policy research.
Strong working knowledge of behavioral health coding, reimbursement structures, and level-of-care distinctions, particularly within Medicaid managed care environments.
Exceptional independent research skills, with the ability to interpret complex payer and regulatory documentation without reliance on templates or third-party summaries.
Analytical judgment is sufficient to identify reimbursement risk, challenge unsupported revenue assumptions, and validate billing and payer data.
Clear written and verbal communication skills, particularly when translating complex behavioral health payer rules for leadership, clients, and internal teams.
Comfort operating in a consulting or advisory environment with shifting priorities, high accountability, and an expectation of precision.