Nira Medical Group

Procurement

• Lead all new payer contract negotiations, managing the end-to-end process from initial outreach through execution, ensuring terms align with organizational goals and market benchmarks.
• Establish and maintain fee schedules and contracted rates for professional services, drug/pharmacy, and ancillary services. Own rate-setting decisions in collaboration with Finance and clinical leadership.
• Maintain, update, and audit all payer allowable tables within Athena and any other relevant systems. Coordinate quarterly or monthly allowable schedule pulls based on payer requirements and internal cadence needs.
• Identify, track, and resolve payment variances resulting from a mismatched allowable between contracted rates and actual payer remittances. Partner with billing and RCM teams to correct discrepancies and prevent recurrence.
• Serve as the primary point of contact for payer inquiries and projects related to contract pricing. Facilitate timely resolution of payer-initiated issues and proactively surface risks to leadership.
• Generate and distribute regular reporting on contract performance, allowable schedules, out-of-network activity, and no-go status. Ensure leadership has the visibility needed for strategic decision-making.
• Conduct out-of-network analyses to evaluate financial exposure and inform contracting strategy. Maintain and distribute no-go reporting to flag payers or services where participation is not financially viable.
• Manage all updates within Athena related to contracts, allowable updates, payer configurations, and rate changes. Ensure system accuracy is maintained continuously, and changes are tested and validated upon implementation.

Contract Management – Revenue Integrity Specialist

Insurance

• Perform intake duties for infusion orders, including creating patient charts, reviewing and entering orders, obtaining clinical requirements, and communicating with prescribers regarding required clinical documentation.
• Verify insurance eligibility, obtain clinical requirements for authorizations, and track patients’ progress.
• Communicate with patients and providers regarding the status of infusion order.
• Perform or assist with enrollment of eligible patients into manufacturer copay assistance programs and/or foundations.
• Educate patients on pre- and post-infusion expectations and answer questions about patient appointments.
• Schedule patient appointments for infusion services.
• Coordinate drug orders prior to infusion appointments.

Contract Management – Revenue Integrity Specialist

Patient Scheduling, Insurance Coordinator