JOB TITLE: Payer Relations Specialist
REPORTS TO: Payer Relations Manager
FLSA STATUS: Non-exempt
GENERAL PURPOSE OF THE JOB:
The individual in this position will support and collaborate with the Payer Relations Manager and Revenue Operations Department. This person is responsible for administrative work to ensure compliance with payer requirements. Assists in the analysis, negotiation, management and maintenance of new and existing payer contracts and fee schedules.
PRIMARY DUTIES AND RESPONSIBILITIES
· Oversees internal and external credentialing requirements.
· Reviews and monitors provider portals and national, state government websites and industry news for updates affecting payer compliance including billing, credentialing requirements, referrals, authorizations and payments.
· Responds to general questions from payers and contracted vendors regarding credentialing, contracting, billing, authorization, referral or other subjects related to responsibilities of Payer Relations Department.
· Requests and maintains systems and records related to reimbursement and fee schedules, contracts and policies.
· Maintains spreadsheets used for tracking provider and practice information, payer contracts and fee schedule assignments.
· Responds and coordinates with internal departments related to contracts and credentialing.
· Assists Payer Relations Manager in contract analysis and/or negotiation.
· Effectively develops and fosters relationships with payer contacts.
· Supports in identifying payer contracting opportunities.
· Collaborates with the Revenue Operations department to identify and resolve erroneous reimbursement issues to ensure proper billing, reimbursement, and compliance with payer and state regulations in accordance with MPP policies and procedures.
SECONDARY DUTIES AND RESPONSIBILITIES:
· Coordinates special projects at manager’s request.
· Maintains agendas and minutes for Payer Relations meetings.
· Maintains department policies and procedures.
· Maintains provider information 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.
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.
- 1-3 years of Commercial and Government provider credentialing experience.
- 1-3 years of experience in Payer or Provider Relations role.
- High school graduate or equivalent.
· Must be able to manage multiple projects simultaneously in a multifaceted organization.
- Must have strong written and verbal communication.
- Ability to work independently and in a team environment.
- Strong customer service, negotiation, and interpersonal relationship skills.
- Excellent time management and organizational skills with ability to prioritize assignments, maintain effective filing systems, and meet deadlines.
- Strong attention to detail.
- Proficiency in Microsoft applications, specifically Excel and Word.
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.
Position Type: Full Time/Regular
Location: Lakewood, CO