Job Purpose

The Contract Governance Manager is responsible for establishing, implementing, and overseeing governance frameworks for payer contracts to ensure compliance, consistency, and financial optimization. The role ensures that all contracts are aligned with CCHI regulations, NPHIES requirements, and internal policies, while safeguarding revenue integrity, minimizing risk, and enhancing transparency across the organization.

Roles and Responsibilities

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 Contacts

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.