Contract Governance Manager

Job Purpose

Organizational Accountabilities

• Establish and maintain contract governance frameworks across all payer agreements.
• Ensure compliance with CCHI regulations, NPHIES standards, and internal policies.
• Enhance revenue integrity by ensuring proper implementation and monitoring of contract terms.
• Minimize financial, legal, and operational risks associated with payer contracts.
• Ensure standardization and consistency of contract management practices across the organization.
• Support audit readiness and regulatory compliance.
• Promote transparency, accountability, and control in contracting processes.

Functional Accountabilities

• Develop and implement contract governance policies, procedures, and standards.
• Establish contract lifecycle management processes including creation, approval, renewal, and termination.
• Define roles, responsibilities, and approval matrices for contract management.
• Ensure all contracts comply with CCHI regulations, payer requirements, and healthcare laws.
• Align contracts with NPHIES workflows and digital health requirements.
• Monitor regulatory changes and ensure contracts are updated accordingly.
• Oversee contract implementation and ensure accurate system configuration in HIS and billing systems.
• Ensure proper interpretation and application of contract terms across RCM functions.
• Monitor adherence to contract terms and identify deviations.
• Identify risks related to contract gaps, pricing errors, or contract misinterpretation.
• Implement controls to prevent revenue leakage and ensure correct reimbursement.
• Conduct regular contract audits and compliance reviews.
• Develop dashboards and KPIs to monitor contract performance and compliance.
• Analyze reimbursement trends, variances, and payer performance.
• Provide insights and recommendations to senior management.
• Act as the primary governance liaison between RCM, Finance, Legal, and Commercial teams.
• Coordinate with payer contracting teams and external stakeholders.
• Provide guidance and training to internal teams on contract governance.
• Ensure proper maintenance of a centralized contract repository.
• Implement version control, audit trails, and documentation standards.
• Ensure accessibility and security of contract records.
• Identify opportunities to automate contract management and governance processes.
• Support implementation of contract management systems.
• Enhance efficiency and control through digital tools and analytics.

Key Internal Stakeholders

• Revenue Cycle Management (Billing, Coding, Claims, and Collections).
• Finance and Accounting.
• Medical and Clinical Departments.
• Commercial / Business Development.
• IT and Systems Teams.

Key External Stakeholders

• Insurance companies and TPAs.
• Council of Cooperative Health Insurance (CCHI).
• NPHIES platform stakeholders.
• External auditors and consultants.

Job Qualifications And Requirements

• Knowledge and Experience
• 8–11 years of experience in healthcare contracting, RCM, or financial governance.
• Minimum 3–5 years in a governance, managerial, or leadership role.
• Strong experience in payer contracts and contract lifecycle management.
• In-depth knowledge of CCHI regulations and Saudi insurance frameworks.
• Strong understanding of NPHIES workflows and claims ecosystem.
• Experience in financial controls, audit, and compliance frameworks.
• Familiarity with contract management systems and ERP/HIS platforms.

Education And Certifications

• Bachelor’s degree in Healthcare Administration, Law, Finance, Business Administration, or a related field (Required).
• Master’s degree (MBA or Healthcare Management) (Preferred).
• CPA / CMA / SOCPA certification (Preferred).
• Contract Management Certification such as CCCM or CPCM (Preferred).
• Healthcare Revenue Cycle certification (Preferred).
• Training in CCHI and NPHIES (Preferred).
• Risk management or governance certifications (Preferred).

Skills

• Strong negotiation and communication skills.
• Analytical and financial assessment skills.
• Attention to detail and contract accuracy.
• Understanding of healthcare revenue cycle processes.
• Ability to interpret legal and contractual language.
• Problem-solving and decision-making skills.
• Stakeholder management and coordination.
• Proficiency in Microsoft Excel and reporting tools.
• Knowledge of healthcare systems including HIS and billing systems.

Summary**Experience Required****