Payor Relations Supervisor

Description:

Job Title: Payor Relations Supervisor

Job Type: Full-time

Location: Hybrid; 2 to 3 days per week in office.

We are seeking a highly motivated Payor Relations Supervisor to join our team. The Payor Relations Supervisor builds and maintains relationships with internal and external sources involved in the IDR/No Surprise appeals process; and participates in the development of contractual/response language and negotiation strategy. In addition, serves as a liaison between PAA and IDR entities; as well as the credentialing department and other internal staff on implementation of contracts and compliance to contract terms to ensure providers are receiving appropriate reimbursement, to ensure rules and requirements are followed and to prepare for renegotiations. The Payor Relations Supervisor interacts with internal and external parties regarding communication/questions about payments/refunds pertaining to IDR process, other rates and terms, rate structure and development and reconciliation of contract provisions and disputes. The Payor Relations Supervisor must have exceptional organizational and time management skills, deadline driven, very detail oriented, highly analytical, resourceful, and flexible to adapt to ongoing project changes or departmental needs.

Responsibilities:

• Oversight of entire IDR process; ensuring strict guidelines and timelines are met to allow for favorable decisions with multiple IDR entities on a daily basis.
• Able to effectively manage IDR payment tracking reports, fee payments/refunds, batch creations and offer submissions.
• Manage ineligible/inconsistent determinations, monitoring preference list of entities. Communicate with IDR entities.
• Able to build and maintain relationships with payor representatives in coordination with our RCM and Contracting teams for projects involving payor contact.
• Build and maintain payer analytics capability to benchmark utilization and reimbursement levels across the growing office network.
• Evaluate new payers/networks and their fees for participation.
• Work with outside consultants and contracted third parties with respect to payer relations.
• Thoroughly analyze and review rates and utilization to drive mutually beneficial outcomes for patients and providers.
• Analyze fee schedules by specialty and code relative to historical company utilization and industry comps.
• Track contracts and anniversary dates to ensure annual rates are implemented correctly and on time.
• Quantify rate impacts during negotiations and monitor ongoing utilization and expected fee changes.
• Assist in developing and maintaining appropriate policies, procedures, and controls for dental contracts and payer contracting activity.
• Effectively manage Tolerance report for underpayments and Good Faith estimates as needed.
• Serves as a subject matter expert on payor issues and communicates recommendations to the appropriate team proactively to reduce and prevent future denials.
• Manages the implementation process for all new or renegotiated managed care agreements.
• Reviews payor websites and external information, staying current with changes to payor policies and other initiatives.
• Ensures compliance with all Health Insurance Portability and Accountability Act (HIPAA) standards.
• Performs other duties as required or assigned within the scope of responsibility.

Requirements:

• Bachelor's degree in healthcare administration, business administration, or related field
• Minimum of 3 years of experience in payor relations or related field
• Strong understanding of contractual/response language and negotiation strategy
• Excellent communication and negotiation skills
• Ability to build and maintain relationships with internal and external sources
• Strong attention to detail and ability to manage multiple tasks simultaneously

We are an equal opportunity employer and welcome all qualified candidates to apply. If you are a highly motivated individual with a passion for payor relations, we encourage you to apply for this exciting opportunity.

Requirements:

Essential Duties and Responsibilities

Duties include but are not limited to:

• Oversight of entire IDR process; ensuring strict guidelines and timelines are met to allow for favorable decisions with multiple IDR entities on a daily basis.
• Able to effectively manage IDR payment tracking reports, fee payments/refunds, batch creations and offer submissions.
• Manage ineligible/inconsistent determinations, monitoring preference list of entities. Communicate with IDR entities.
• Able to build and maintain relationships with payor representatives in coordination with our RCM and Contracting teams for projects involving payor contact.
• Build and maintain payer analytics capability to benchmark utilization and reimbursement levels across the growing office network.
• Evaluate new payers/networks and their fees for participation.
• Work with outside consultants and contracted third parties with respect to payer relations.
• Thoroughly analyze and review rates and utilization to drive mutually beneficial outcomes for patients and providers.
• Analyze fee schedules by specialty and code relative to historical company utilization and industry comps.
• Track contracts and anniversary dates to ensure annual rates are implemented correctly and on time.
• Quantify rate impacts during negotiations and monitor ongoing utilization and expected fee changes.
• Assist in developing and maintaining appropriate policies, procedures, and controls for dental contracts and payer contracting activity.
• Effectively manage Tolerance report for underpayments and Good Faith estimates as needed.
• Serves as a subject matter expert on payor issues and communicates recommendations to the appropriate team proactively to reduce and prevent future denials.
• Manages the implementation process for all new or renegotiated managed care agreements.
• Reviews payor websites and external information, staying current with changes to payor policies and other initiatives.
• Ensures compliance with all Health Insurance Portability and Accountability Act (HIPAA) standards.
• Performs other duties as required or assigned within the scope of responsibility.

Minimum Qualifications

To perform this job successfully an individual must be able to perform each essential duty to a satisfactory standard. 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.

Education: Associates degree required or equivalent years of relevant work experience. Bachelor’s degree in business, healthcare, or related field preferred

Experience: Two (2) to three (3) years of experience in a healthcare setting is required. A minimum of two (2) years to three (3) years of leadership experience. Familiarity with coding, billing, collections, in and out network metrics, reading and interpreting EOBs/remits, and customer service. Knowledge of compliance and regulatory standards governing health plans and patient care. Prior fee analysis and negotiation experience is a plus. No surprises/IDR process knowledge highly preferred. Project Management skills preferred.

License/Certification: Valid driver’s license required.

Language Skills: Demonstrated ability to exercise professional oral and written communication skills with all internal and external audiences.

Computer Skills: Experience with medical billing software systems is required. Superior knowledge of software and other systems and portals used within RCM. Proficiency in MS Office, especially Word, Excel, and PowerPoint, with a focus on creating and developing spreadsheets, presentations, and reports effectively and efficiently. Experienced with Power BI and Availity are highly encouraged.

Reasoning Ability: Ability to organize and manage personal workload and the workload over all areas of oversight. Ability to achieve and maintain strong working knowledge of anesthesia billing operation practices. Ability to analyze and assess the production effort of all areas of oversight. Ability to develop and execute corrective action plans.

Additional Skills/Requirements: Customer service excellence. Strong verbal and written communication skills. Basic accounting and medical terminology. Knowledge of regulatory and third-party payer requirements to ensure compliance.

Physical Demands and Work Environment

The physical demands described here are representative of those that must be met by any employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to sit, stand, walk, use hands to finger, handle, or feel, reach with hands and arms, and talk or hear. The employee is occasionally required to stoop, kneel, crouch, or crawl. The employee must occasionally be able to work in a standing position for long periods of time and up to the entire shift. Travel is primarily local during the day, although some out-of-area and overnight travel for conferences may be required. Air travel may also be required.