Manager, Payer Relations

2 months ago

Springfield, Illinois, United States Springfield Clinic Full time

The Payer Relations Manager is responsible for assisting with the financial and administrative oversight of payer relations and contracting with commercial payers on behalf of Springfield Clinic. Works closely with departmental staff and Clinic physicians to develop and maintain a portfolio of participating network contracts. Ensures internal support is provided so that contractual obligations can easily be met while enhancing revenue and patient access, and providing general assistance and backup support to the Director of Managed Care.

Job Relationships
Reports to the Director of Managed Care

Principal Responsibilities

  • Collaborate directly with the Director of Managed Care and all Operations staff to support all payer relations business needs.
  • Collaborate with patient accounting, quality management, practice operations and credentialing teams as directed to ensure that all payer contractual obligations are met.
  • Maintain relationships with provider relations representatives with all contracted managed care plans.
  • Work closely with payers to ensure proper understanding of payer's guidelines, contractual terms, and the processing of Springfield Clinic claims.
  • Coordinate recurring payer meetings.
  • Partner with patient accounting and compliance colleagues to resolve improper reimbursement as well as ensuring we are billing per the payer's guidelines, ensure proper reimbursement and compliance with payer.
  • Provide verbal and written communication to all applicable Springfield Clinic practice operations, ancillary, and billing teams related to updates of payer information such as payer provider manuals, provider bulletins and other notices relating to eligibility, covered services, pre-authorization requirements, coding and claim requirements, appeal processes, etc.
  • Maintain all associated documentation for all health plan/payer relationships.
  • Provide administrative coordination and oversight of payer contracts in accordance with contract goals, objectives, and activities.
  • Serve as the primary contact for any contract questions; respond to internal and external inquiries related to network status for Commercial, Managed Medicaid, and Medicare Advantage plans.
  • Provide insight, direction, and support to credentialing specialists including but not limited to network status, issues related to credentialing, and answering all questions related to payer plans.
  • Provide applicable payer reporting.
  • Analyze and coordinate execution of single case agreements and requested contracts including communications with other teams.
  • Develop and present educational materials for clinical staff related to online portals/systems utilized to obtain prior authorizations in compliance with all payer plans.
  • Comply with the Springfield Clinic incident reporting policy and procedures.
  • Adhere to all OSHA and Springfield Clinic training & accomplishments as required per policy.
  • Provide excellent customer service and adhere to Springfield Clinic's Code of Conduct and Ethics Standards.
  • Perform other job duties as assigned.

Education/Experience

  • Bachelor's degree in business, healthcare administration, or other related field is required.
  • Minimum two (2) years' experience in health care related payer relations/contracts is required.
  • Microsoft Office experience is required.

Knowledge, Skills and Abilities

  • Ability to produce reports and analyze data is required.
  • Strong verbal and written communication skills are required.
  • Must have strong group presentation skills.

Working Environment

  • This job operates in a professional office environment.
  • Routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.
  • Most of the time will be spent in the office, with occasional travel possible.

PHI/Privacy Level
HIPAA1


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