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

• 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