Payor Relations Jobs (NOW HIRING)

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Job Summary:

Under the direction of the Director of Payor Relations, the Payor Relations Specialist is responsible for managing relationships with payors and providers to ensure proper managed care arrangements for the organization. The Payor Relations Specialist will provide accurate and thorough information regarding fee schedules and implementation, products and product changes, and contract measures and metrics, including those pertaining to quality and efficiency. In addition, the Payor Relations Specialist will be responsible for the resolution of questions or concerns from both payors and physicians, taking the primary role in supporting both Payor Contracting and Provider Enrollment functions related to payor issue resolution. The Payor Relations Specialist will also support the Director of Payor Relations and contracting function in appropriate financial modeling of less complex financial arrangements and practice acquisition revenue impact analyses.

Duties and Responsibilities:

• Responsible for communications with the organization's provider network regarding payor fee schedule updates, contractual requirements, product changes, and notifications pertaining to managed care contract negotiations and adherence.
• Provide key data in support of financial arrangements with health insurance plans.
• Work closely with Revenue Cycle team and Provider Enrollment regarding health plan provider set up and provide appropriate assistance in serving as a primary interface with health plans to solve systemic (vs. transactional) claim payment problems and other issues.
• Support Director in modeling less complex re-negotiation proposals, as directed.
• Responsible for working with multiple internal and external stakeholders to ensure communication of key objectives and responsibilities to support contract negotiations and adherence.
• Support contracting initiatives in accordance with organizational business requirements, quality incentive programs and unit cost trend budget requirements.
• Ensure new rates for health plan agreements are successfully communicated within the organization.
• Ensure that health plans are compliant with rate loading and other operational terms in accordance with contract effective date.
• Work effectively with multiple departments to ensure that contracts are compatible with organizational operations and structure.
• Maintains corporate payor contract files.
• Adheres to all safety policies and procedures in performing job duties and responsibilities while supporting a culture of high quality and great customer service.
• Performs other duties that may be necessary or in the best interest of the organization.

Experience Requirements

Three (3) - Five (5) years supporting a managed care function at either health plan or provider organizations, including experience with moderate financial analysis, knowledge of contract language provisions and payor relations-oriented issue resolution.

Knowledge, Skills and Abilities Requirements

• Must possess strong understanding of the local managed care environment, including, but not limited to, managed care policies and procedures, reimbursements mechanisms, and practice management/medical office procedures.
• Detail oriented, professional attitude, reliable
• Management and organizational skills to support the leadership of this function
• Ability to follow or provide verbal & written instructions with sufficient grammar and spelling skills to avoid mistakes or misinterpretations
• Interpersonal skills to support customer service, functional, and team mate support needs
• Able to communicate effectively in English, both verbally and in writing
• Mathematical and/or analytical ability for intermediate problem solving
• Intermediate computer operation:
• Proficiency with Microsoft Word, Outlook and especially Excel
• Specialty knowledge of systems relating to job function
• Knowledge of state and federal regulations for this position; general understanding of HIPAA guidelines

All your information will be kept confidential according to EEO guidelines.