Job Description
The Payer Contracting Specialist partners with the SVP of Revenue Cycle on the implementation of payor strategy, focusing on payor operations, client services, and process improvement. The focus of this role is network development/contracting. In addition, this role ensures resolution of payor issues received from the field, leadership, or other internal departments, tracking of opportunities, and continual documentation and improvement of processes. This is an entry-level position. Training is available for this role.
This position works onsite in our Northbrook, Illinois corporate office.
Responsibilities
- Assist with negotiation of managed care agreements with payors, health systems, IPA's and other entities Including language and rate negotiation.
- Gain working knowledge of various reimbursement strategies and ability to analyze rate proposals.
- Develop ability to identify unfavorable contract language in agreements.
- Assist with implementation of payor strategy in partnership with the Manager of Contracting and Payor Relations.
- Maintains a thorough operational knowledge of contractual agreements and specific contractual language with Payors.
- Coordinatewith credentialing regarding demographic updates and needs related to contracting efforts.
- Collaborates with Operations, legal, billing, and compliance to track and resolve payor issues, including payment and/or billing disputes.
- Continually create, document, and improve processes to provide clear communication throughout the lifecycle of contracting efforts.
- Manages contract assignments and any documentation relevant to the negotiation, strategy, and/or implementation of the contract.
- Proactively monitor and report on current contracting efforts.
- Partner with internal team to ensure that contracting efforts align with company and divisional goals.
- Communicate with relevant stakeholders to ensure contract commitments are operationalized.
- Additional duties as assigned
Requirements
- Bachelor's degree, required. Focusin Health Care Administration, Managed Care Contracting or similar degree preferred
- Prior health care provider or health plan contracting, contract operations, service operations, or provider relations experience, required
- Interest in Health Care operations required
Benefits
- Health
- Dental
- Vision
- 401k
- PTO
Qualification
Bachelor's Degree
Key skill Required
- Billing
- Clear Communication
- Communication
- Compliance
- Contracting
- Development
- Documentation
- Health Care Operations
- Implementation
- Leadership
- Managed Care
- Partnership
- Process Improvement
- Reimbursement
- Strategy
- Training
