Network Payor Relationship Specialist - Southwestern Health Resources
Southwestern Health Resources, Pittston, PA, United States
Network Payor Relationship Specialist - Southwestern Health Resources
Network Payor Relationship Specialist - Southwestern Health Resources
Southwestern Health Resources is looking for a highly Network Payor Relationship Specialist. Is that you?
Work Hours: Full Time Days (8:00am-5:00pm) for 40 hrs/week (remote work allowed at manager's discretion)
Department Highlights
Hybrid Position
Gain a sense of accomplishment by contributing to a teamwork environment.
Receive excellent mentorship, comprehensive training, and dedicated leadership resources.
Contribute and work on a cross functional team
What You Will Do
Manage Payor relationship from Leadership Level to day to day contacts for complex global payor operational issues, including but not limited to revenue integrity, payor policy and guideline changes, and coordination of projects. (10%)
Develop and maintain effective relationships and regular contact with key payor stakeholders as well as executive and operational leaders within SWHR and SWHR Physician Network to ensure secure and long-term business relationships. (10%)
Identify and provide resolution of operational issues to ensure SWHR Physician Network expectations are satisfied; coordinate implementation of solutions to prevent future issues; provide feedback and status updates. (10%)
Serve as liaison between Payor and SWHR Physician Network operations management and organizational functional units. (10%)
Coordinate, communicate and deliver contracted Payor information to ensure successful implementation of onboarding SWHR Physicians or modifications to existing SWHR Physicians. (10%)
Provide SWHR Physicians and staff with educational training regarding managed care contracts, government, ACO programs and payer changes/updates, including but not limited to in-services, webinars, MCO help desk inquiries, MCO Alerts, orientation materials/newsletters, presenting at centralized operational and revenue cycle meetings and maintaining all resources and tools (Managed Care Guidelines). (10%)
Collaborate with SWHR leadership and SWHR Physician Network to identify initiatives that improve Payor efficiency and effectiveness. (10%)
Develop, execute and report monthly/quarterly KPIs for Payor efficiency and effectiveness for the achievement of growth objectives for contracted payors. (10%)
Makes recommendations on Payor efficiency barriers to SWHR Market & Payer Relations during open negotiations. (10%)
Executes newly contracted Payor Offers to SWHR Physician Network (planning, communications, provides answers to inquires). (10%)
What You Need Education
Associate’s Degree Related Field 2 years’ additional experience in lieu of Bachelor's Degree (Req)
Bachelor Degree Related Field (Req)
Experience
3 Years to include experience in a client‑facing account management role in the health care industry/payor relations (Commercial, Medicare, Medicaid) with exposure to ACO, Claims, or Payor Contracts (with Bachelor's Degree). (Req)
5 Years to include experience in a client‑facing account management role in the health care industry/payor relations (Commercial, Medicare, Medicaid) with exposure to ACO, Claims, or Payor Contracts (with Associate’s Degree). (Req)
Knowledge of billing, coding, and payor reimbursement methods within health care. (Req)
Skills
Proficient in MS PowerPoint and ability to present to large and small crowds
Project management skills, and strong planning and organizational skills.
Project delivery methodology skills
Exceptional facilitation skills and communicating strategies and adjusting strategies based on the feedback of stakeholders.
Highly detailed oriented with the ability to troubleshoot issues/SWHR Physician Network or Payor requests quickly and provide organizational guidance.
Ability to hold organization as well as SWHR Physician Network or Payor accountable to deliver on operational requirements.
Strong data, analytics, and quantitative acumen
Familiarity with processes of CPT, HCPCS, ICD-9, coverage and reimbursement.
Familiarity with health insurance claim forms, including CMS-1500, explanation of benefits, and prior authorization forms, and superbills charge tickets to troubleshoot cases where billing, claims submission or documentation errors may occur
Self-managed, self-starter with the ability to support multiple concurrent projects and meet tight delivery timelines
Strong project management approach with excellent critical thinking and problem-solving skills
Work requires strong knowledge in EPIC, Cactus, MS Office Suite, Salesforce, VISIO
Supervision Individual Contributor
ADA Requirements Working Indoors 67% or more
Physical Demands Sedentary
Travel Requirements Local Travel locally to SWHR Physician Network Providers
Additional Information
Job Field: Clerical/Admin
Shift: Day Job
Schedule: Full-time
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Southwestern Health Resources is looking for a highly Network Payor Relationship Specialist. Is that you?
Work Hours: Full Time Days (8:00am-5:00pm) for 40 hrs/week (remote work allowed at manager's discretion)
Department Highlights
Hybrid Position
Gain a sense of accomplishment by contributing to a teamwork environment.
Receive excellent mentorship, comprehensive training, and dedicated leadership resources.
Contribute and work on a cross functional team
What You Will Do
Manage Payor relationship from Leadership Level to day to day contacts for complex global payor operational issues, including but not limited to revenue integrity, payor policy and guideline changes, and coordination of projects. (10%)
Develop and maintain effective relationships and regular contact with key payor stakeholders as well as executive and operational leaders within SWHR and SWHR Physician Network to ensure secure and long-term business relationships. (10%)
Identify and provide resolution of operational issues to ensure SWHR Physician Network expectations are satisfied; coordinate implementation of solutions to prevent future issues; provide feedback and status updates. (10%)
Serve as liaison between Payor and SWHR Physician Network operations management and organizational functional units. (10%)
Coordinate, communicate and deliver contracted Payor information to ensure successful implementation of onboarding SWHR Physicians or modifications to existing SWHR Physicians. (10%)
Provide SWHR Physicians and staff with educational training regarding managed care contracts, government, ACO programs and payer changes/updates, including but not limited to in-services, webinars, MCO help desk inquiries, MCO Alerts, orientation materials/newsletters, presenting at centralized operational and revenue cycle meetings and maintaining all resources and tools (Managed Care Guidelines). (10%)
Collaborate with SWHR leadership and SWHR Physician Network to identify initiatives that improve Payor efficiency and effectiveness. (10%)
Develop, execute and report monthly/quarterly KPIs for Payor efficiency and effectiveness for the achievement of growth objectives for contracted payors. (10%)
Makes recommendations on Payor efficiency barriers to SWHR Market & Payer Relations during open negotiations. (10%)
Executes newly contracted Payor Offers to SWHR Physician Network (planning, communications, provides answers to inquires). (10%)
What You Need Education
Associate’s Degree Related Field 2 years’ additional experience in lieu of Bachelor's Degree (Req)
Bachelor Degree Related Field (Req)
Experience
3 Years to include experience in a client‑facing account management role in the health care industry/payor relations (Commercial, Medicare, Medicaid) with exposure to ACO, Claims, or Payor Contracts (with Bachelor's Degree). (Req)
5 Years to include experience in a client‑facing account management role in the health care industry/payor relations (Commercial, Medicare, Medicaid) with exposure to ACO, Claims, or Payor Contracts (with Associate’s Degree). (Req)
Knowledge of billing, coding, and payor reimbursement methods within health care. (Req)
Skills
Proficient in MS PowerPoint and ability to present to large and small crowds
Project management skills, and strong planning and organizational skills.
Project delivery methodology skills
Exceptional facilitation skills and communicating strategies and adjusting strategies based on the feedback of stakeholders.
Highly detailed oriented with the ability to troubleshoot issues/SWHR Physician Network or Payor requests quickly and provide organizational guidance.
Ability to hold organization as well as SWHR Physician Network or Payor accountable to deliver on operational requirements.
Strong data, analytics, and quantitative acumen
Familiarity with processes of CPT, HCPCS, ICD-9, coverage and reimbursement.
Familiarity with health insurance claim forms, including CMS-1500, explanation of benefits, and prior authorization forms, and superbills charge tickets to troubleshoot cases where billing, claims submission or documentation errors may occur
Self-managed, self-starter with the ability to support multiple concurrent projects and meet tight delivery timelines
Strong project management approach with excellent critical thinking and problem-solving skills
Work requires strong knowledge in EPIC, Cactus, MS Office Suite, Salesforce, VISIO
Supervision Individual Contributor
ADA Requirements Working Indoors 67% or more
Physical Demands Sedentary
Travel Requirements Local Travel locally to SWHR Physician Network Providers
Additional Information
Job Field: Clerical/Admin
Shift: Day Job
Schedule: Full-time
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