Manager, Payor Relations & Contracting (Remote)

Remote Position

Job Summary: 

Responsible for negotiations of Managed Care agreements and maintaining strong Payor relationships. Manages the planning process for all contract renewals and negotiations including assessment of historical performance, identification of payor specific issues as well as opportunities and recommendations which incorporate strategic and critical thinking approaches resulting better outcomes for the practice. Works with Clinical departments and Revenue Cycle to resolve payor related issues.

Job Duties:

Develops, maintains, and negotiates strong relationships with Commercial, Medicare and Medicaid payors.

Analyzes and evaluates impact of specific managed care arrangements upon the practice. Prepares and analyzes financial reports and maintains fee schedule data that accurately reflects contract language, rates, and intent.

Works closely with Clinical Operations, the Revenue Cycle, and payors to resolve denial and payment issues.

Responsible for negotiating single case Letters of Agreement with non-contracted payors

Works closely with Legal Counsel in reviewing contract language.

Monitors and communicates changes to payor guidelines and policies.

Interprets, explains, and adheres to all regulatory guidelines, regulations, and policies.

Oversees the daily operations and directs the work of the department personnel.

Performs all other duties assigned.

Education:

Bachelor’s degree in business administration or health care field is required..

Masters Degree preferred.

Experience:

Seven (7) years experience is required. Physician group and Facility contract negotiation experience preferred.

Additional Information