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Lead Analyst, Payor Relations Specialist

4 weeks ago


Charlotte, North Carolina, United States Providence Anesthesiology Associates Full time
Job Summary

We are seeking a highly skilled Lead Analyst, Payor Relations to oversee and manage our payer relations team. The successful candidate will be responsible for managing Independent Dispute Resolution (IDR), contracts, and the accurate processing of over and underpayments. This role will be crucial in maintaining and enhancing our relationships with payers, ensuring compliance with contractual obligations, and refining our financial procedures to optimize revenue cycles.

Key Responsibilities
  • Independent Dispute Resolution (IDR)
    • Lead the team in managing and resolving payer-related disputes, ensuring timely and effective resolution.
    • Monitor IDR processes and outcomes, providing regular updates to senior management.
    • Develop and implement strategies to streamline IDR workflows, reducing resolution times.
    • Ensure compliance with regulatory requirements and payer guidelines.
  • Contracts Management
    • Assist with negotiating, executing, and managing payer contracts.
    • Ensure all contract terms are met and maintain accurate records of contract details.
    • Regularly review and update contracts to reflect changing regulations and organizational needs.
    • Help develop metrics to evaluate contract performance and adherence to terms.
  • Over and Underpayments
    • Lead the team in identifying, analyzing, and resolving over and underpayments from payers.
    • Assist in establishing and monitoring key performance indicators (KPIs) to track over and underpayment resolution rates.
    • Help implement procedures to minimize future discrepancies and improve payment accuracy.
    • Provide detailed reports on payment discrepancies and resolution efforts to senior management.
  • Metrics and Performance Indicators
    • IDR Resolution Time: Track the average time taken to resolve disputes.
    • Contract Compliance Rate: Measure the percentage of contracts fully compliant with terms and regulations.
    • Over and Underpayment Resolution Rate: Monitor the rate at which payment discrepancies are identified and resolved.
    • Accuracy of Payments: Calculate the percentage of payments processed without discrepancies.
    • Team Efficiency: Assess the productivity and efficiency of the payer relations team in handling assigned tasks.