Payor Contracting Specialist / Managed Care

Payor Contracting Specialist / Payer Contracting Specialist / Managed Care Specialist

 

SUMMARY


This position recruits, negotiates, executes and processes new and renegotiates current contracts for group health/urgent care, workers? compensation and physical therapy services on a national and regional basis. Fee analysis development to ensure adequate reimbursement on all contracts that supports company and business objectives. Coordination of data management for the contract module in the AS 400 system. In addition, the individual will interact with other internal team members to generate, collect and protect US HealthWorks revenue.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Develops and maintains professional, effective relationships with Managed Care Payors, Workers? Compensation Payors, Employer Accounts, IPA?s, Case Management Companies and TPA?s, on a regional and national level.
Coordinates communication of new and renegotiated contracts by notifying appropriate areas.
Maintains a through knowledge of each contract?s status, reimbursement terms, billing authorization and coding.
Assists operations with Accounts Receivables and identifying correct or incorrect reimbursement.
Works directly with Payors and in-house Account Managers, Trainers, and Center Managers to increase contract compliance, timely payments and understanding of co-pay collections.
Data management of key aspects of the contracts and contracting process into the web-based matrix and into the AS 400 computer system.
Develop training materials as needed for the various product lines to educate front & back office personnel on contract language and participate in presentations when required.
Research financial reports and data bases for analysis to ensure best rate contracted.
Seek creative solutions to reduce organizational barriers and offer feedback on contract processes for quality improvement purposes.

SUPERVISION

KNOWLEDGE, SKILLS AND ABILITIES

?Excellent communication and strong analytical skills.
?In-depth knowledge of workers? compensation and managed care organizations.
?Strong understanding of heath care strategies, and financial/contracting arrangements.
?Solid proven hands-on negotiation skills and payor contracting experience.
?Able to function independently with minimal supervision, yet able to work effectively in a team environment.
?Detail oriented and good organizational skills.
?Ability to multi-task on various projects and at various levels.
?Ability to change direction and project priorities as needed.REQUIREMENTSEDUCATION and/or EXPERIENCE

?Bachelor?s Degree preferred but will consider significant experience in a managed care/insurance organization in lieu of degree.
?Minimum of three years hands-on contracting experience in managed care or Workers? Compensation field.
?Customer Service Orientation and Experience.
?Proven experience with reimbursement methodologies and coding standards.

COMPUTER SKILLS:

?Skilled in Excel, Access, Word and PowerPoint.