Payer Negotiation Specialist

Payer Negotiation Specialist Clearwater, FL Job Details 21 hours ago Qualifications Collaborate with healthcare professionals Revenue cycle management Term negotiation Appeals Record keeping Contract documentation review Contract management Contract review Insurance prior authorization Medicare Caseload management Regulatory compliance Mid-level Contract management in healthcare 3 years HCPCS Contract drafting Medical insurance appeals management Healthcare compliance Communication skills Cross-functional communication Progress tracking (project management tasks) Full Job Description Position Summary The Single Case Agreement (SCA) Specialist is responsible for securing reimbursement and coverage for services, therapies, or medical technologies on a patient-by-patient basis through negotiation with health plans. This role serves as a key liaison between providers, payers, patients, and internal teams to ensure timely access to care when standard coverage pathways are not available. About RomTech ROMTech® is a groundbreaking telemedicine technology with remote clinical oversight and fully customizable therapy protocols. The PortableConnect® (the device) enables gentle, therapeutic movement within a comfortable range of motion. Light, easy, and frequent sessions make it easier for the body to heal and recover.

The result:

patients recover and return to their activities of daily living more quickly, with less pain and drugs, and with better mobility. Key Responsibilities o Initiate and lead negotiations with commercial and government health plans to establish Single Case Agreements (SCAs) o Secure appropriate reimbursement rates, terms, and coverage conditions for out-of-network or non-contracted services o Communicate clinical and economic value propositions to payer medical directors and contracting teams o Manage a pipeline of patient-specific cases from intake through agreement execution and reimbursement o Coordinate with clinical, reimbursement, and intake teams to gather necessary documentation (e.g., medical necessity, prior authorizations) o Track case progress, timelines, and outcomes to ensure timely patient access Documentation & Compliance o Draft, review, and finalize SCA contracts in collaboration with legal and compliance teams o Ensure all agreements adhere to payer requirements, regulatory standards, and internal policies o Maintain accurate records of negotiations, approvals, and contract terms Cross-Functional Collaboration o Partner with providers, revenue cycle teams, and patient access teams to align strategy and communication o Educate internal stakeholders on payer requirements, negotiation strategies, and SCA processes o Serve as a subject matter expert on reimbursement pathways for non-covered or out-of-network services Qualifications 3-7+ years of experience in healthcare reimbursement, payer relations, managed care contracting, or revenue cycle Proven experience negotiating with health plans (SCAs, LOAs, or out-of-network agreements preferred) Strong understanding of prior authorization, medical necessity, and appeals processes Knowledge of commercial insurance, Medicare, and Medicaid structures Key Skills Strong negotiation and influencing skills Ability to communicate clinical and financial value effectively Detail-oriented with strong organizational and case management abilities Comfortable working in fast-paced, high-stakes patient access environments Excellent written and verbal communication skills Preferred Experience Experience working with specialty therapies, medical devices, or high-cost procedures Familiarity with

CPT/HCPCS

coding and reimbursement methodologies Prior interaction with payer medical directors or utilization management team