Salaried Payor Relations Jobs (NOW HIRING)

Overview
Responsible for the coordination of payor contracting processes on behalf of Carle Foundation Entities, including all Hospital and Ancillary Services, Carle Provider Groups, and Ambulatory Surgery Centers. Develops and maintains the information necessary to monitor and report payor contract rates and terms impacting other departments within Carle, such as Patient Financial Services, General Accounting and Patient Access. Coordinates payor and provider contracting programs on behalf of the Carle Foundation. Ensures compliance with the contract terms, particularly the renewal and termination provisions.
Responsibilities
Cultivate and maintain strong relationships with payors.
Promptly and effectively manages inquiries from payors and internal patient care departments about participation in new agreements, and billing disputes. May include research related to claims review and provider load issues.
Responsible for developing and maintaining database and information on all managed care contracts, including a system for tracking and identifying annual contract renewals.
Facilitate Payor Escalation meetings with Revenue Cycle Staff.
Provides support for the contracting process, from initiation to implementation and completion. This includes obtaining input from impacted administrative and clinical departments regarding new contracts and changes to existing contracts.
Participate in and manage action items from monthly Payor meetings with Carle Billing Teams, Case Management and Provider Enrollment Teams.
Responsible for coordination and communication of ongoing payor changes. This includes submission of Revenue Cycle Systems and training requests for Epic changes and updates.
Serve as liaison and subject matter expert for internal and external customers regarding contracting concerns, payor relations and reimbursement discrepancies.
Responsible for the mapping of new plan codes and participation on the Payor Plan Code committee to guide net revenue modeling, discrepancy tracking and reporting.
Manage annual charge increases and contractual impacts that will affect various internal departments.
Obtain, maintain and distribute payor fee schedules to ensure accurate reimbursement rates.
Responsible for reviewing contract language and payor policies to confirm if new procedure or services are reimbursable.
Coordinate the collection of data for Facility Recredentialing for various payor contracts.
Collaborate cross-functionality of internal billing, coding and compliance teams to ensure timely and accurate claim submissions.
Ensure compliance with all federal, state and local regulations, as well as industry best practices and changes in payor reimbursement methodologies.
Qualifications
Certifications: , Education: Associate's Degree (Required); Experience In Lieu of Education, Work Experience: Medical payor
Carle Health Company Overview
Find it here.
Discover the job, the career, the purpose you were meant for. At Carle Health, we're committed to fostering a workplace where every team member feels valued, respected and empowered, where passion and purpose come together to positively impact the lives of our patients and our communities. Find it all at Carle Health.
Our nearly 17,000 team members and providers work together to support patient care across central and southeastern Illinois. We've grown to include eight, award-winning hospitals and a multispecialty provider group with more than 1,500 doctors and advanced practice providers. We're developing the next generation of providers and healthcare professionals through Carle Illinois College of Medicine, the world's first engineering-based medical school, and Methodist College. Carle BroMenn Medical Center, Carle Foundation Hospital, Carle Health Methodist Hospital, Carle Health Proctor Hospital, Carle Health Pekin Hospital, and Carle Hoopeston Regional Health Center hold Magnet® designations, the nation's highest honor for nursing care. We offer opportunities in several communities throughout central Illinois with potential for growth and life-long careers at Carle Health.
We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. Carle Health participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization. | For more information: human.resources@carle.com.
Salary Range
The compensation range for this position is $26.86per hour - $44.86per hour. This represents a good faith minimum and maximum range for the role at the time of posting by Carle Health. The actual compensation offered a candidate will be dependent on a variety of factors including, but not limited to, the candidate's experience, qualifications, location, training, licenses, shifts worked and compensation model.
Carle Health offers a comprehensive benefits package for team members and providers. To learn more visit careers.carlehealth.org/benefits.