83 Specialty Rx Payer Relations Manager Jobs Hiring Near You

I.JOB SUMMARY
The Manager, Physician Payer Relations is responsible for providing a wide range of project, programmatic and administrative support functions for the Physician Services Department. This position will devote his/her time to providing support to members and their practice staff as well as the AOA Affiliates. He/she will also handle a variety of different tasks, many of which will vary on a day-to-day basis. The Manager will regularly interact and work collaboratively with members, insurers, AOA/AOIA leaders, and other affiliated organizations on matters of strategic importance to AOA/AOIA member physicians and their practices.

The Manager, Physician Payer Relations will be responsible for: continuously monitoring key sources for changes in industry practices and policies; helping develop and refine materials and tools to keep internal and external stakeholders informed of emerging issues; and maintaining an in-depth awareness of members' payment- and/or practice-related concerns. He/she will serve as the conduit between the AOA, its members and private insurers. Will be responsible for managing and overseeing operational initiatives underway related to private insurers. He/she will be required to handle a large and diverse portfolio of work, which will involve simultaneously serving as an individual contributor, and a subject matter expert and resource for other teams and departments within the broader AOA/AOIA organization. The individual will help advance the mission of the AOA/AOIA and support the organization's member physicians by developing, assessing, and enforcing policies, procedures and response processes that ensure all payment- and practice-related issues are addressed in an accurate, comprehensive and timely manner by the Physician Services Department. He/she will also develop and launch a strategic plan to ensure AOA members are acutely aware of and well informed on contemporary payment- or practice-related issues, which may include: payment methodologies and delivery models; network contracting and participation; revenue cycle management; operating a private practice; patient engagement and population health; billing and collections; and coding and documentation.

II.ESSENTIAL FUNCTIONS

A.Consults with physicians and staff to understand problems related to denial of payments, documentation, coding and audits as well as other practice related issues.
B.Completes intake documentation for member issues and requests; serves as the first point-of-contact and liaison between individual members and the Physician Services team.
C.Performs independent research, collects data, analyzes findings to respond to member inquiries and presents recommendations to the Director of Practice Management and Education and Physician Services' leadership on key issues or trends identified (e.g., coding and documentation, medical audit protocols, reimbursement policies); responds to requests for information and develops summaries and briefings.
D.Maintains tracking logs and records to ensure all issue are addressed in a timely, accurate and comprehensive manner; provides summaries and reports on open and closed issues to Physician Services leadership as requested.
E.Works directly with payers to influence policy decisions, advantageous payment reforms, and expanded coverage and access to physicians' services; helps ensure an optimal outcome for AOA members and DOs by directly advocating or directing advocacy efforts as issues, disputes or opportunities arise.
F.Develops, maintains and continuously strengthens relationships with public and private payers, hospitals/health systems, medical groups and practices, and allied organizations or associations; manages the design and implementation of strategic outreach initiatives to educate public and private insurers on the distinctive philosophy and practice of osteopathic medicine, as well as the unique challenges faced by DOs in the payment and practice management realms.
G.Supports and participates in development, assessment, refinement and improvement activities for the services and programming provided by the Physician Services Department and the AOA/AOIA.
H.Develops and/or advises on the development of communications materials (e.g., issue summaries, presentations, white papers, fact sheets, talking points, alerts, reference guides) for AOA/AOIA member physicians and their practices regarding payment- and/or practice-related matters.
I.Provides administrative, project management, strategic planning and other needed support for the Physician Services Department.
J.Supports and assists in the efforts to identify and define educational needs of membership and staff.
K.Partners with AOA/AOIA teams or departments outside of Physician Services on a variety of payment or practice-related issues.
L.As needed, attends meetings and events with members and other stakeholders; reports out on meeting activities, outcomes and findings to Physician Services' leadership team.
M.Handles and maintains highly confidential, proprietary and/or sensitive information.
N.Works with Director of Practice Management to monitor department website activities and provision of information.
O.Other duties as assigned.

III.QUALIFICATIONS / EXPERIENCE

Mandatory

A.Bachelor's degree in a relevant field (e.g., public policy, healthcare administration or related healthcare field) or equivalent work experience.
B.Previous experience in a health insurance company, medical practice, hospital/health system or healthcare-related organization.
C.Strong subject matter expertise in coding and documentation, practice management, the business of medicine, health policy, and payer relations.
D.In-depth understanding of the evolving payment landscape for physicians and the core methodologies employed under fee-for-service and value-based arrangements.
E.Demonstrated competence for assessing and managing competing priorities in a deadline-driven environment.
F.Keen attention to detail and capacity to work independently with minimal guidance and/or supervision on assigned tasks.
G.Aptitude for disseminating and explaining complex information in a clear, concise, and accurate manner in all forms of written and oral communication.
H.Strong interpersonal skills with ability to work well in teams.
I.Superior communication, organizational and problem-solving skills.
J.Advanced proficiency in Microsoft Office applications; experience with CRM tools and applications.

Preferred

A.Previous experience with professional and/or membership associations representing physicians.

IV.WORKING CONDITIONS

Physical Demands
Work is generally sedentary in nature, but requires occasional standing, walking, lifting and moving objects (up to 25 pounds). Requires manual dexterity to use computer, telephone and peripherals. Incumbent may occasionally work prolonged or irregular hours, including evenings and weekends.

Mental Demands
Work is performed in a dynamic environment. Incumbent is expected to be able to quickly adapt to stressful situations, exercise good judgement, communicate effectively orally and in writing, and interact appropriately with internal and external stakeholders.
Office Environment
Work is performed in a normal office environment. Full-time remote work arrangements are not permitted.

Travel
Domestic travel may be required <15 percent of the time.

V.DISCLAIMER

Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time. This description reflects management's assignment of essential functions; it does not proscribe or restrict the tasks that may be assigned. This job description is subject to change at any time.