Upon successful completion, learners will be able to: 1. Distinguish between government-funded and privately-funded payer contract models. 2. Interpret how regulatory agencies (CMS, HHS, state Medicaid agencies) oversee government contracts. 3. Evaluate how contractual clauses (e.g., prompt pay, hold harmless, termination) vary by payer type. 4. Assess the financial and operational impact of managed care and risk-based payment models. 5. Identify best practices for maintaining compliance and reimbursement accuracy under government payer requirements. 6. Apply analytical skills to compare real-world payer contracts and assess their reimbursement implications.

Foundational knowledge in healthcare reimbursement systems, Basic understanding of insurance terminology, claims processing, and regulatory frameworks, and Familiarity with ICD-10/CPT coding, though not required, is advantageous.

1. Students and early-career professionals in health administration, finance, or law pursuing careers in payer-provider relations. 2. Revenue Cycle Analysts and Contract Managers involved in negotiations and reimbursement analysis. 3. Healthcare Compliance Officers ensuring adherence to CMS and payer policies. 4. Policy Analysts, Auditors, and Legal Professionals working in health regulation or reimbursement. 5. Healthcare Administrators and Managers overseeing payer relations or compliance.