Overview
Join the Cleveland Clinic team, where you will work alongside passionate caregivers and provide patient-first healthcare. Cleveland Clinic is recognized as one of the top hospitals in the nation. At Cleveland Clinic, you will receive endless support and appreciation and build a rewarding career with one of the most respected healthcare organizations in the world. As a Payer Contract Specialist, you will be responsible for collecting and analyzing managed care contract information to support effective contract implementation, compliance monitoring, operational efficiency, and customer service initiatives. You will disseminate contract details to provider organizations, facilities, and operational departments, ensuring alignment and understanding across all stakeholders. In addition, you will research and recommend solutions to issues related to claim payments, reimbursement, and operational processes. This role plays a key part in facilitating the resolution of outstanding claims to optimize revenue and promote patient satisfaction. A caregiver in this position works remotely from 8:00 a.m. – 4:30 p.m., with flexible start times available as early as 7:00 a.m. or as late as 9:00 a.m. One day per quarter is required to be worked onsite. Responsibilities
Collect and assimilate managed care contract information to support contract implementation, compliance monitoring, operations and customer service functions. Act as an internal resource to community hospitals, institutes and other internal departments. Provide contract-specific information and resolution of issues to payors and internal customers. Research, track and manage issues related to claim payment, reimbursement, operations and general information requests. Manage and track escalated, high-profile and highly complex issues, making recommendations to resolve them. Negotiate case-specific agreements with local, regional, national and international payors for tertiary referrals, as well as agreements for other services and Cleveland Clinic facilities. Gather, research and distribute contract-related information for compilation, communication and implementation. Prepare communications, summary sheets, quick reference guides and implementation checklists for assigned payor contracts. Contribute materials for the Managed Care newsletter and websites. Coordinate informational sessions for payor contract implementation and education. Arrange and facilitate meetings with payor representatives for contract maintenance or problem resolution. Minimum qualifications
Bachelor\'s Degree in Business, Marketing, Healthcare or a related field OR High School Diploma/GED and three years of related experience Strong desktop computer skills (Word, Excel, Access, PowerPoint, Outlook) Ability to relate effectively to physicians and hospital administration and to handle service issues and complaints in a professional and diplomatic manner Preferred qualifications
One year of managed care or provider relations experience Experience with payers and claims Experience presenting and running meetings Excel experience Physical Requirements
Ability to communicate and exchange accurate information. Ability to perform work in a stationary position for extended periods. Ability to work with physical records or operate a computer or other office equipment. In some locations, ability to travel throughout the hospital system. In some locations ability to move up to 25 lbs. Personal Protective Equipment
Follows standard precautions using personal protective equipment as required. Pay Range
Minimum Annual Salary: $43,200.00 Maximum Annual Salary: $65,880.00 The pay range displayed on this job posting reflects the anticipated range for new hires. A successful candidate’s actual compensation will be determined after taking factors into consideration such as the candidate’s work history, experience, skill set and education. The pay range displayed does not include any applicable pay practices (e.g., shift differentials, overtime, etc.). The pay range does not include the value of Cleveland Clinic’s benefits package (e.g., healthcare, dental and vision benefits, retirement savings account contributions, etc.).
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Join the Cleveland Clinic team, where you will work alongside passionate caregivers and provide patient-first healthcare. Cleveland Clinic is recognized as one of the top hospitals in the nation. At Cleveland Clinic, you will receive endless support and appreciation and build a rewarding career with one of the most respected healthcare organizations in the world. As a Payer Contract Specialist, you will be responsible for collecting and analyzing managed care contract information to support effective contract implementation, compliance monitoring, operational efficiency, and customer service initiatives. You will disseminate contract details to provider organizations, facilities, and operational departments, ensuring alignment and understanding across all stakeholders. In addition, you will research and recommend solutions to issues related to claim payments, reimbursement, and operational processes. This role plays a key part in facilitating the resolution of outstanding claims to optimize revenue and promote patient satisfaction. A caregiver in this position works remotely from 8:00 a.m. – 4:30 p.m., with flexible start times available as early as 7:00 a.m. or as late as 9:00 a.m. One day per quarter is required to be worked onsite. Responsibilities
Collect and assimilate managed care contract information to support contract implementation, compliance monitoring, operations and customer service functions. Act as an internal resource to community hospitals, institutes and other internal departments. Provide contract-specific information and resolution of issues to payors and internal customers. Research, track and manage issues related to claim payment, reimbursement, operations and general information requests. Manage and track escalated, high-profile and highly complex issues, making recommendations to resolve them. Negotiate case-specific agreements with local, regional, national and international payors for tertiary referrals, as well as agreements for other services and Cleveland Clinic facilities. Gather, research and distribute contract-related information for compilation, communication and implementation. Prepare communications, summary sheets, quick reference guides and implementation checklists for assigned payor contracts. Contribute materials for the Managed Care newsletter and websites. Coordinate informational sessions for payor contract implementation and education. Arrange and facilitate meetings with payor representatives for contract maintenance or problem resolution. Minimum qualifications
Bachelor\'s Degree in Business, Marketing, Healthcare or a related field OR High School Diploma/GED and three years of related experience Strong desktop computer skills (Word, Excel, Access, PowerPoint, Outlook) Ability to relate effectively to physicians and hospital administration and to handle service issues and complaints in a professional and diplomatic manner Preferred qualifications
One year of managed care or provider relations experience Experience with payers and claims Experience presenting and running meetings Excel experience Physical Requirements
Ability to communicate and exchange accurate information. Ability to perform work in a stationary position for extended periods. Ability to work with physical records or operate a computer or other office equipment. In some locations, ability to travel throughout the hospital system. In some locations ability to move up to 25 lbs. Personal Protective Equipment
Follows standard precautions using personal protective equipment as required. Pay Range
Minimum Annual Salary: $43,200.00 Maximum Annual Salary: $65,880.00 The pay range displayed on this job posting reflects the anticipated range for new hires. A successful candidate’s actual compensation will be determined after taking factors into consideration such as the candidate’s work history, experience, skill set and education. The pay range displayed does not include any applicable pay practices (e.g., shift differentials, overtime, etc.). The pay range does not include the value of Cleveland Clinic’s benefits package (e.g., healthcare, dental and vision benefits, retirement savings account contributions, etc.).
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