Manager of Payer Relations, Contracting, & Credentialing

Job Title: Manager of Payer Relations, Contracting, & Credentialing

Reports To: Executive Vice President, Revenue Cycle Management

Location: Remote

Schedule: Monday-Friday 8am-5pm MST

Compensation: $70,000-90,000/year

Northpoint Recovery Holdings, LLC began 2009 as Ashwood Outpatient and officially launched the Northpoint platform in 2015. Now celebrating 10 years of growth in 2025, Northpoint is a leading behavioral healthcare provider offering evidence-based treatment for adults with substance use and co-occurring disorders through the Northpoint Recovery brand, and mental health treatment for adolescents through Imagine by Northpoint . Operating under an in-network, commercial insurance model, Northpoint has grown exclusively through de novo expansion—from two facilities to seventeen across the Western U.S.—with more planned in both existing and new markets. We’re guided by core values of humility, heart, inspiration, and conviction . Our mission is simple: saving lives and restoring relationships by helping people get their lives back, and treating every individual with empathy and respect.

POSITION SUMMARY: As a key member of the Northpoint team, reporting to the Executive Vice President of Revenue Cycle Management, the Manager of Payer Relations, Contracting & Credentialing is responsible for advancing Northpoint’s payer strategy through effective payer relationship management, contract negotiation and performance, network development, and credentialing oversight across the organization’s markets. This position serves as a key organizational liaison with commercial and government payers and is responsible for developing and maintaining productive payer relationships, identifying opportunities to strengthen network participation and reimbursement, resolving payer-related barriers, and supporting Northpoint’s continued expansion into existing and new markets.

The Manager leads the full lifecycle of payer contracting, including contract evaluation, negotiation, rate strategy, amendments, reimbursement terms, and operational implementation of contractual requirements. The position partners closely with Revenue Cycle, Utilization Review, Finance, Clinical Operations, Business Development, and Executive Leadership to evaluate payer performance, identify emerging risks and opportunities, and ensure payer strategies support patient access, revenue integrity, and organizational growth.

The position also maintains leadership oversight of Northpoint’s credentialing, recredentialing, enrollment, licensing, and related regulatory processes, ensuring facilities and providers remain appropriately credentialed and compliant with payer, state, federal, CAQH, Medicare, and Medicaid requirements. As Northpoint continues to expand, this role is expected to build scalable payer relations, contracting, and credentialing infrastructure capable of supporting new markets, service lines, acquisitions, and de novo growth.

ESSENTIAL RESPONSIBILITIES AND DUTIES INCLUDE:

Payer Relations & Strategy

Serve as the primary operational relationship owner for assigned health plans and payer partners.

Develop and maintain strategic relationships with payer representatives, network leaders, contracting teams, and other key stakeholders.

Establish a structured payer engagement cadence for Northpoint’s highest-impact payer relationships.

Identify and escalate payer issues affecting patient access, reimbursement, authorization, claims payment, or operational performance.

Partner with RCM and UR leadership to identify recurring payer behaviors and develop coordinated resolution strategies.

Monitor payer and market developments that may create financial, operational, or access opportunities or risks.

Support payer strategy for new markets, de novo facilities, acquisitions, new service lines, and geographic expansion.

Maintain a payer opportunity and escalation pipeline, including contract opportunities, network gaps, reimbursement opportunities, and unresolved payer issues.

Provide regular executive-level reporting regarding payer relationships, negotiations, network development, reimbursement opportunities, and material risks.

Contracting & Reimbursement Strategy

Develop payer negotiation strategies in partnership with the EVP of RCM and Finance using reimbursement data, market intelligence, utilization trends, and organizational growth.

Build an effective multi-state licensing and credentialing strategy and process that can scale nationally, coordinating between providers, medical boards, payers, and government agencies.

Evaluate reimbursement performance and identify underperforming contract terms or rates requiring renegotiation.

Develop and maintain payer contract summaries identifying reimbursement terms, authorization requirements, timely filing provisions, appeal requirements, exclusions, termination provisions, and other financially material terms.

Partner with RCM analytics to quantify the financial impact of proposed rate changes and contract amendments.

Identify opportunities to expand network participation and improve patient access across Northpoint markets.

Ensure negotiated contract terms are operationalized across Admissions, UR, Clinical Operations, Billing, and other affected functions.

Provider Credentialing, Enrollment & Compliance

Manages Northpoint’s full lifecycle of contract management, negotiations, rate increases, HCPCS/CPT requirements, and professional services

Responsible for the overall management of all in-network and out-of-network contracting and negotiations for the organization and employed providers

Coordinate with clinical operations, licensing agencies, insurance carriers, and other appropriate organizations to complete credentialing and recredentialing applications

Maintain a database for licensing, contracting, and credentialing and continue to develop new processes and procedures, ensuring full utilization of systems and platforms

Monitor entity-specific rules, policies, and procedures, ensuring compliance with accrediting organization and payer requirements; develop, recommend, and/or implement changes, revisions, and enhancements as appropriate to the current operating environment.

Other duties as assigned.

Payer Performance & Revenue Intelligence

Collaborate with internal stakeholders such as the Director of RCM, Utilization Review Dept, Finance, and Charge master Systems/Analytics function to look at:

Reimbursement by payer

Authorization barriers

Contractual adjustment trends

Overpayment and Underpayments

Out-of-network exposure

Network adequacy/opportunities

Rate performance

Contract compliance

Patient access barriers

QUALIFICATIONS/REQUIREMENTS FOR POSITION:

Bachelor’s degree in business administration, health management, or commensurate experience required

Minimum of five (5) years of experience in managed care contracting and provider credentialing

Minimum of three (3) years of hospital and/or payer negotiation and payer analysis experience

Knowledge of fee-for-service and/or fee-for-value reimbursement methods, delegated credentialing workflows, and working knowledge of all major payers

Strong at synthesizing information; easily distill easy-to-understand takeaways and next steps, diagnose problems, see patterns, and come up with targeted solutions

Self-Starter; organize processes, improve workflows that already exist, and continuously strive for more efficiency

Impeccable attention to detail; able to catch areas of opportunity in data or workflows quickly and document processes in a concise but thorough manner

Must work well under pressure, able to focus on multiple priorities while maintaining focus, attention to detail and connecting all the dots

Proficiency with Microsoft Office Suite

PREFERRED KNOWLEDGE AND SKILLS:

Knowledge of behavioral health care HCPCS/CPT coding