Payer Negotiation Specialist

JOB DESCRIPTION

ROMTech's Mission is to enable people to achieve superior health outcomes through engagement, data-driven insight, innovative technology, and exceptional service.

ROMTech is a medical technology company that has created and patented a revolutionary medical device and telemedical platform which delivers in-home rehabilitative care. Our disruptive technology has proven to yield faster recoveries and better outcomes with unmatched patient compliance. We began in orthopedics and have entered scale-up of our orthopedic business. We are now leveraging our core technology, infrastructure, and first mover position to enter cardiology, followed by other adjacent markets. Having created this new lane, we have a unique opportunity to serve as the global leader in the business, technology, and science of recovery, and to bring life-changing help to many millions of people.

Position Title: Payer Negotiation Specialist
Department: Market Access
Reports To: Director of Market Access
Location / Work Environment: Clearwater, FL (Onsite)
Worker Classification: W2 Employee
FLSA Status: Non-Exempt
Job Level: Standard

Job Purpose

The Payer Negotiation Specialist is responsible for securing reimbursement pathways and facilitating access to ROMTech services by negotiating agreements with commercial and government health plans. This role serves as a primary liaison between payers, providers, revenue cycle teams, and patient access stakeholders to optimize reimbursement outcomes, support patient access, and minimize financial barriers to care. The position leverages expertise in payer policies, coverage criteria, single case agreements (SCAs), letters of agreement (LOAs), prior authorization requirements, and reimbursement methodologies to drive favorable payer outcomes and support organizational growth objectives.

Key Responsibilities

Essential Duties

• Negotiate single case agreements (SCAs), letters of agreement (LOAs), out-of-network agreements, and other reimbursement arrangements with health plans to secure patient access and reimbursement.
• Develop and implement payer engagement strategies designed to improve reimbursement outcomes and support business objectives.
• Communicate clinical, operational, and financial value propositions effectively during payer negotiations.
• Collaborate with providers, revenue cycle teams, patient access teams, and other internal stakeholders to align reimbursement strategies and communication efforts.
• Educate internal stakeholders regarding payer requirements, reimbursement processes, negotiation strategies, and SCA workflows.
• Serve as a subject matter expert on reimbursement pathways for non-covered, partially covered, or out-of-network services.
• Analyze health plan policies, medical necessity criteria, prior authorization requirements, and coverage guidelines to identify reimbursement opportunities and risks.
• Support appeals and escalation processes related to coverage determinations, medical necessity denials, and reimbursement disputes.
• Maintain thorough documentation of payer interactions, negotiations, agreements, and reimbursement outcomes.
• Monitor payer trends, policy updates, and market developments that may impact reimbursement strategies.
• Collaborate with cross-functional teams to develop recommendations that improve access, reimbursement, and operational effectiveness.
• Ensure compliance with applicable organizational policies, payer requirements, and regulatory standards.

Other Functions

• Participate in departmental meetings, training activities, and process improvement initiatives.
• Assist with reporting, data collection, and analysis related to payer performance and reimbursement outcomes.
• Support special projects related to market access, contracting, and reimbursement operations.
• Performs other related duties as assigned to support operational and business needs.