22nd September, 2021
Job Type: Direct
Shift: 8 hour days. 8am - 5 pm
Employee meets the minimum requirements of the following competencies:
1. Oversees the development, implementation, and management of payer strategy and operations of payer relations and payer contract
management for the health system.
2. Ensure complex payer information and reports are analyzed and summarized to provide accurate in-depth analysis and timely
recommendations to key internal individuals and leadership are provided on a monthly/quarterly basis. Collaborate across health
system re-occurring payer issues and assist in developing strategies to address.
3. Develop and implement communication tools to ensure new and/or updated policy/procedures or other payer communications are
provided to key individuals throughout health system.
4. Provide support to health system Managed Care negotiating team to support effective contract negotiations and to ensure ongoing
payer compliance by resolving problems and advising of new payer protocols/policies/procedures.
5. Ensure standardized monthly/quarterly/ad-hoc meetings with Managed Care organizations occur and problems/issues are resolved in a
timely fashion. Maintains a master calendar and schedule of Managed Care Organization meetings to ensure meeting requirements are
satisfied in accordance with Payer Relations Communication Plan across entire health system. Work with departments to develop the
Payer Relations Communication Plan according to departmental/physician practice/specialist needs.
6. Maintain collaborative relationship with health systems key internal departments (patient accounts, finance, medical records,
information systems, admissions, utilization review, physicians) in order to quickly resolve any internal issues identified by Managed
Care Organization and participant in the development/revision of necessary policy/procedure changes including but not limited to
billing, cash-posting, medical records documentation, registration, admissions, pre-certification, and utilization management activities.
7. Oversees the development of educational materials and in-services for internal department staff and providers regarding contract
provisions. Development of training materials including research and collaboration with subject matter experts.
8. Oversee contract system maintenance related to both acute and ambulatory care areas across the healthcare system including
physician practice, hospital, and other affiliated entities.
9. Monitor for payer performance including comparing actual reimbursement rates in comparison to contracted discount rates and fee
schedules. Identify and recommend areas of opportunity to improve contract performance and reimbursement optimization to PFS
10. Work with System Director to assist and facilitate new contract agreements and existing contract changes.
11. Coordinate with credentialing specialist for the facility enrollment issues.
12. Directly perform hospital enrollment including maintaining Medicare and Medicaid enrollments as well as other payer enrollments and
13. Work with payers and Revenue Cycle staff to update physician fee schedules as needed.
14. Oversee the daily reconciliation process for estimated contractuals within the Contract management system.
15. Participate as needed in projects as they relate to specific areas of expertise.
Employee meets all minimum competency requirements of position.
This position oversees the development, implementation and management of payer strategy and operations for payer relations and payer
contract management for the health system. This position is responsible for all healthcare system patient financial contract management
including contract maintenance, analysis, reporting, and assisting with new contracts. This position also coordinates with credentialing specialist
for provider enrollment issues as well as directly manages and maintains hospital enrollment processes. Maintenance includes overseeing the
input/maintenance of the contracts within the Contract Management system as well as overseeing the routine reconciliation of the files into and
out of the system for performance and integrity. Analysis and reporting will include payer scorecard development and communication both
internally and externally. This position will work closely with system Revenue Cycle leadership and team members systems analysts,
Accounting, Leadership, and Information Services. This position will also work closely with and coordinate routine meetings and education with
payer representatives on behalf of the health system for improved contract performance and operations. This position does not provide direct
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 qualified individuals with
disabilities to perform the essential functions.
Education and/or Experience
Bachelors Degree required within 1 year of hire.
5-7+ years experience in areas of network management, Contracting, hospital and physician reimbursement, , contract management,
managed care, payer credentialing, billing, coding, and overall revenue cycle strongly preferred.
Progressively responsible work experience in healthcare in a Provider Relations/Customer Service environment or equivalent role
Comprehensive knowledge of healthcare managed care principles and understanding of contract language, fee schedules,
reimbursement methodologies, CPTs, HCPCS, APCs, DRGs, and OPPS required.
Certifications, Licenses, Registrations
Ability to read, interpret contracts, general business periodicals, professional journals, technical procedures, and governmental
Ability to write reports, business correspondence, and policies and procedures.
Ability to effectively present information and respond to questions from groups of managers, employees, clients, customers, regulatory
agencies, auditors, and the general public.
Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, and percentages. Ability to apply
concepts of basic algebra.
Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule forms.
Other Skills and Abilities
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