Skip to Main Content

Payer Relations Representative

MPP Infusion Centers Dallas, TX

  • Expired: over a month ago. Applications are no longer accepted.
Job Description

JOB TITLE: Payer Relations Representative

REPORTS TO: VP of Innovation/ Payer Relations Manager

FLSA STATUS: Exempt

GENERAL PURPOSE OF THE JOB:

The Payer Relations Representative will assist in all contracting, credentialing, and payer operations support work. In this role, the Representative will work to identify target payers within the market through the understanding of referring practices’ mix, pharma needs, and members covered. The individual will assist in developing regional payer strategies and in any payer contract related work. This position works internally with various departments and executive leaders, as well as externally with referring practices, health plans, and payer contacts. The successful candidate for this position will demonstrate the ability to execute and accomplish goals set forth by the organization. Key success factors for this role include experience and competence in relationship building, concise presentation of complex healthcare policy and reimbursement information, and the ability to quickly identify solutions to address both internal and external customer needs.

PRIMARY DUTIES AND RESPONSIBILITIES

Builds and maintains strong, positive, and respectful relationships with the network representatives associated with each contracted and non-contracted plan and payer.

Responsible for developing/managing relationships with targeted Health Plans and Payers.

Evaluates payer landscape by region and state to provide guidance to executive team on payer contracts to pursue in each market.

Works with leadership to complete analysis and assists in the negotiations of contracts that meet the Company’s financial goals in compliance with all state, federal, provider, and corporate requirements.

Assists and serves as lead with the completion and implementation of any new regionally assigned contracts.

Works closely with payers to ensure proper understanding of payer billing guidelines, contractual terms and claims processing requirements.

Collaborates with the Revenue Operations department to identify and resolve reimbursement problems to ensure proper billing, reimbursement, and compliance with payer and state regulations in accordance with MPP policies and procedures.

Works with other department representatives on identified training needs to ensure consistent understanding of payer guidelines, contractual terms, reimbursement methodology, and MPP policies and procedures.

Responsible for maintaining all associated documentation for all Health Plan/Payer relationships.

Monitors changes in government regulations, develops recommendations regarding company policies and practices, and potentially impacted health plan/payer relationships.

Monitor’s payer notices describing changes in its policies, procedures, or protocols that may result in a reduction in payment to MPP and/or, potentially increase MPP administrative costs, and works collaboratively with team to assess those impacts and initiate written objection to the payer.

Monitors any/all shifts in coverage for major employers from one insurer to another that could significantly impact (positive or negative) MPP’s contracting economics.

Proactively identifies methods and means to address recurring issues. Identifies opportunities to create efficiencies and add value to the intake team.

Responsible for understanding the complexities of out of network coverage and reimbursement.

Ability to initiate contracts/single patient agreements with payers.

SECONDARY DUTIES AND RESPONSIBILITIES:

· Coordinates special projects at supervisor’s request.

· Maintains patient records and confidentiality.

· Effectively communicates, develops, and interfaces with the MPP corporate office to promote a positive image with clinics, patients, visitors, co-workers, physicians, office personnel, and external agencies.

· Encourages team building with staff; demonstrates and supports the MPP PRIDE culture

· Attends necessary meetings related to clinic and corporate office activities.

· Performs other duties as assigned.

QUALIFICATIONS:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

· 2 years of experience in a payer and/or provider relations role, with demonstrated experience in successfully operationalizing and administering managed care contracts and payer relationships.

· Candidate must be comfortable in making sales calls to payers and developing relationships within markets.

· Must be able to manage multiple projects simultaneously in a highly matrixed organization, have an exceptionally strong customer service focus, and superb organizational and communication skills.

· College degree is strongly preferred, but not required.

WORK ENVIRONMENT & PHYSICAL DEMANDS:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. The physical demands described below are representative of those that must be met by an employee to successfully perform the essential functions of this job. The noise level in the work environment is usually low to moderate.

The employee is frequently required to sit and infrequently required to stand, lift and/or move up to 50 pounds. While performing the duties of this job, the employee is required to sit, stand; walk and talk, climb stairs, and hear. Requires excellent visual dexterity and manual dexterity.

 

Company Description
When your physician prescribes infusion therapy, you have a choice as to where to receive your care. At MPP Infusion Centers, our patients can expect to receive their medication in a relaxing, comfortable and professional setting. We work with the doctor to provide a treatment plan designed especially for the patient. As an indication of the MPP Infusion Centers dedication to quality and our patients, the Joint Commission (the nation's oldest and largest standards-setting and accrediting body in health care) issued their Gold Seal of Approval for Ambulatory Health Care Accreditation to all MPP Infusion Centers. We want you at the heart of our company’s PRIDE and to help us bring our core values to life with Passion, Respect, Innovation, Dedication, and Excellence.

MPP Infusion Centers

Why Work Here?
MPP is a great Company to work for! There are opportunities for growth within our organization.

When your physician prescribes infusion therapy, you have a choice as to where to receive your care. At MPP Infusion Centers, our patients can expect to receive their medication in a relaxing, comfortable and professional setting. We work with the doctor to provide a treatment plan designed especially for the patient. As an indication of the MPP Infusion Centers dedication to quality and our patients, the Joint Commission (the nation's oldest and largest standards-setting and accrediting body in health care) issued their Gold Seal of Approval for Ambulatory Health Care Accreditation to all MPP Infusion Centers. We want you at the heart of our company’s PRIDE and to help us bring our core values to life with Passion, Respect, Innovation, Dedication, and Excellence.

MPP Infusion Centers's Logo

Address

8144 Walnut Hill Lane

Dallas, TX
USA

Industry

Business

Website

View all jobs at MPP Infusion Centers