Contracting and Payer Relations Specialist
Pennsylvania Mountains Healthcare Alliance, Du Bois, NE, United States
PMHA is seeking a
Contracting and Payer Relations Specialist
to support our Director of Contracting and Payer Relations and VP of Revenue Cycle in managing payer relationships and contract performance across our network of member hospitals. This role plays an important part in the
analysis, administration, and lifecycle management of payer contracts , helping ensure accurate reimbursement and effective collaboration between healthcare providers and insurance payers. Primary scope of work includes hospitals, hospital-based physicians, physician practices, and ancillary provider payor contracts including commercial, managed Medicare and managed Medicaid lines of business. The position works closely with hospital leadership, internal departments, and payer organizations to analyze payment trends, resolve reimbursement issues, and educate and support hospital staff. This position is mostly remote with occasional travel to our member hospitals or our main office in DuBois, PA.
Key Responsibilities Payer Contract Management
Support the full lifecycle of payer contracts, assist in maintaining fee and rate schedules, and monitor contract compliance
Payment Analysis & Issue Resolution
Investigate payment discrepancies and reimbursement issues, identify root cause, and monitor payment accuracy and performance metrics
Build and maintain productive relationships with payer organizations and participating hospitals, coordinate payer meetings, and communicate policy updates and changes
Reporting & Analytics
Prepare reports and data analyses, assist leadership with data requests, and support implementation and use of contract management tools
Process Improvement
Identify opportunities to improve contract management processes, assist in organization and documentation, and support development of standardized materials
Qualifications The ideal candidate will possess the following minimum qualifications:
BS or BA in Health Administration, Health Management, Finance, Accounting, or related field required
3 years’ experience in healthcare contracts, revenue cycle, patient access, payer relations, or finance required
Proficiency in Microsoft Office Suite applications is required
A commitment to excellent customer service
The ideal candidate will also possess the following:
Working knowledge of contractual, health insurance, and operational issues related to healthcare delivery
Working knowledge of healthcare claims, provider, eligibility, and quality/value-based care data
Understanding of managed care metrics
Critical thinking and problem-solving skills
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Contracting and Payer Relations Specialist
to support our Director of Contracting and Payer Relations and VP of Revenue Cycle in managing payer relationships and contract performance across our network of member hospitals. This role plays an important part in the
analysis, administration, and lifecycle management of payer contracts , helping ensure accurate reimbursement and effective collaboration between healthcare providers and insurance payers. Primary scope of work includes hospitals, hospital-based physicians, physician practices, and ancillary provider payor contracts including commercial, managed Medicare and managed Medicaid lines of business. The position works closely with hospital leadership, internal departments, and payer organizations to analyze payment trends, resolve reimbursement issues, and educate and support hospital staff. This position is mostly remote with occasional travel to our member hospitals or our main office in DuBois, PA.
Key Responsibilities Payer Contract Management
Support the full lifecycle of payer contracts, assist in maintaining fee and rate schedules, and monitor contract compliance
Payment Analysis & Issue Resolution
Investigate payment discrepancies and reimbursement issues, identify root cause, and monitor payment accuracy and performance metrics
Build and maintain productive relationships with payer organizations and participating hospitals, coordinate payer meetings, and communicate policy updates and changes
Reporting & Analytics
Prepare reports and data analyses, assist leadership with data requests, and support implementation and use of contract management tools
Process Improvement
Identify opportunities to improve contract management processes, assist in organization and documentation, and support development of standardized materials
Qualifications The ideal candidate will possess the following minimum qualifications:
BS or BA in Health Administration, Health Management, Finance, Accounting, or related field required
3 years’ experience in healthcare contracts, revenue cycle, patient access, payer relations, or finance required
Proficiency in Microsoft Office Suite applications is required
A commitment to excellent customer service
The ideal candidate will also possess the following:
Working knowledge of contractual, health insurance, and operational issues related to healthcare delivery
Working knowledge of healthcare claims, provider, eligibility, and quality/value-based care data
Understanding of managed care metrics
Critical thinking and problem-solving skills
#J-18808-Ljbffr