Payer Contracting & Provider Enrollment Manager

BIG HEARTS HOME HEALTHCARE SERVICES INC.

Miami, FL Job Details Full-time $85,000

•$95,000 a year 22 hours ago Benefits Health insurance Qualifications Microsoft Excel Medicare Commercial insurance knowledge Contract management experience in healthcare Medicaid health insurance Driver's License Bachelor's degree Medicare regulations Direct contracting Government contract management experience Contracts Management reporting Medicaid regulations Medicaid Healthcare reimbursement methods Terms and conditions negotiation

Full Job Description Position:

Payer Contracting & Provider Enrollment Manager Company:

Big Hearts Home Healthcare Services Location:

Remote

•

United States Employment Type:

Full-Time (40 hours per week)

Salary:

$85,000

•95,000 USD annually, depending on experience About the Position Big Hearts Home Healthcare Services is expanding its skilled nursing, home health, and non-medical home care operations across multiple U.S. states. We are seeking an experienced Payer Contracting & Provider Enrollment Manager to establish and manage relationships with government programs, managed care organizations, commercial insurers, and other major funding sources. The successful candidate must have hands-on experience completing applications, obtaining provider approvals, negotiating reimbursement rates, and executing contracts. Key Responsibilities 1. Medicaid & Medicaid Managed Care Complete Medicaid provider enrollment applications across 8-9 states. Secure contracts with Medicaid Managed Care Organizations (MCOs), including Molina Healthcare, Centene, UnitedHealthcare Community Plan, Elevance Health, and other relevant state-specific plans. Identify and pursue Medicaid Home and Community-Based Services (HCBS) waiver programs. Obtain contracts for personal care, private duty nursing, respite care, and other eligible home-based services. Pursue Managed Long-Term Services and Supports (MLTSS) contracts where applicable. 2. Medicare & Medicare Advantage Coordinate Medicare certification and provider enrollment requirements, including PECOS applications where applicable. Establish Medicare Advantage contracts with Humana, UnitedHealthcare, Aetna, Elevance/Anthem, and other relevant plans. Negotiate competitive reimbursement rates for skilled nursing, therapy, and eligible home health services. Explore opportunities with Special Needs Plans (D-SNPs, C-SNPs, and I-SNPs). 3. Veterans Affairs & Military Healthcare Pursue VA Community Care Network contracts through Optum and TriWest. Identify opportunities within VA Homemaker and Home Health Aide services and other applicable veteran-funded home care programs. Establish TRICARE network agreements through Humana Military and TriWest. Manage all necessary applications, credentialing, and contract negotiations. 4. Commercial Insurance Contracting Secure contracts with major commercial health insurers, including: UnitedHealthcare / Optum Aetna / CVS Health Humana Elevance Health / Anthem Blue Cross Blue Shield plans Cigna Healthcare Other significant regional insurers Negotiate reimbursement rates, service coverage, authorization requirements, and payment terms. Develop relationships with payer network representatives and contracting departments. 5. Additional Government & Institutional Contracts Pursue Program of All-Inclusive Care for the Elderly (PACE) provider agreements. Identify state-funded aging, disability, personal assistance, and community care programs. Pursue contracts and procurement opportunities with Area Agencies on Aging, county agencies, and state departments. Establish partnerships with hospitals, health systems, Accountable Care Organizations (ACOs), and discharge planning programs. Explore post-acute care, hospital-at-home support, and readmission reduction contracts. Identify workers' compensation and automobile injury insurance opportunities. Pursue eligible direct-billing arrangements with long-term care insurance providers and administrators. Identify other significant public and private contracts that fund skilled and non-medical home care services. 6. Provider Enrollment & Credentialing Complete and submit payer applications and supporting documentation. Manage NPI, CAQH, Medicare PECOS, and state-specific enrollment requirements. Coordinate licensing, accreditation, certification, and other eligibility documentation with internal teams. Resolve payer deficiencies and maintain ongoing credentialing and revalidation requirements. Ensure each agency is operationally ready to accept referrals and submit claims following contract approval. 7. Contract Negotiation & Performance Reporting Negotiate reimbursement rates, contract terms, and amendments. Identify the highest-value payer opportunities in each state. Maintain a centralized database of payer applications, contracts, reimbursement rates, and effective dates. Provide weekly reports showing applications submitted, approvals obtained, pending contracts, and outstanding requirements. Develop a payer contracting strategy that supports revenue growth in each market.

Qualifications Required:

Minimum 5 years of payer contracting, provider enrollment, or managed care experience. Demonstrated experience with Medicaid and commercial insurance contracting. Knowledge of Medicare Advantage and home health reimbursement. Experience managing payer applications and contracts across multiple states. Proven ability to negotiate and execute reimbursement agreements. Strong understanding of skilled home health and non-medical home care services. Ability to independently manage applications, follow-ups, negotiations, and approvals. Excellent organizational and communication skills.

Preferred:

Existing relationships with major insurance companies and Medicaid MCOs. VA Community Care Network or TRICARE contracting experience. Familiarity with HCBS waiver programs, PACE, and state-funded home care programs. Experience with Medicare-certified home health agencies. Previous experience establishing payer networks for expanding healthcare companies. Performance Expectations The successful candidate will be responsible for: Developing a comprehensive payer contracting strategy across our 8-9 target states. Identifying the highest-priority payers and funding programs in each state. Completing applications and securing agreements as efficiently as possible, subject to payer requirements. Negotiating competitive reimbursement rates that support profitable operations. Ensuring all contracting opportunities are actively pursued and tracked. Establishing a diversified payer network to support sustainable revenue growth.

Compensation Base salary:

$85,000

•95,000 USD annually. Performance-based incentives may be offered. Full-time remote opportunity with a growing multi-state healthcare organization. How to Apply Applicants should submit: Email to: Resume and relevant professional experience. List of states in which they have completed payer enrollment or contracting. Experience with Medicaid, Medicare Advantage, VA, and commercial insurers. Examples of successfully negotiated contracts and reimbursement agreements. Salary expectations and availability.

Pay:

$85,000.00

•$95,000.00 per year

Benefits:

Health insurance Application Question(s): Which Medicaid programs, MCOs, and commercial insurers they have worked with.? Do you have experience with VA, TRICARE, Medicaid waiver programs, or PACE enrolments? How many states they have managed simultaneously? Can you independently perform both enrollment administration and payer negotiations?

Education:

Bachelor's (Required)

License/Certification:

Driving License (Required)

Work Location:

In person