Payer Negotiation Specialist

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

37 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

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 thejoband 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 thisjob 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 thisjobinclude 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 thisjob. 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.