Senior Payor Relationship Manager

6 days ago

Stamford, Connecticut, United States Pediatric Associates Full time
Job Summary

We are seeking a highly skilled and experienced Senior Payor Relationship Manager to join our team at Pediatric Associates. This is a critical role that requires a deep understanding of payor relationships and the ability to navigate complex contract negotiations.

Key Responsibilities
  • Support the Director of Payor Relations in Value-Based and Fee for Service negotiations, proactively monitoring the payor landscape to maximize the competitive position of Pediatric Associates.
  • Develop and maintain strong payor relationships, serving as the primary point of contact for assigned markets.
  • Facilitate Payor meetings with all VBC and large complex payor relationships for assigned markets.
  • Track and manage the full life cycle for all payor contracts and amendments, from beginning to full execution, including Risk, Value Based, Fee for Service, and Capitation payment methodologies.
  • Escalate contract language concerns to the Managed Care Operations Team.
  • Monitor payor contract performance, including Capitation, Gainshare, Pay for Performance, and Incentive Programs, and identify areas of opportunities.
  • Monitor, track, evaluate, and assist Managed Care Operations in the resolution of payment inconsistencies, including Capitation, Gainshare/Risk, Pay for Performance, and other Incentive arrangements.
  • Coordinate with the Managed Care Operations to ensure compliance with state and federal regulations for contract terms and legal regulations that may impact the performance of the contract for assigned markets.
  • Resolve and appropriately escalate all payment, loading, payor communications, and requests.
  • Perform rate evaluation based on modeling and analysis and evaluate/monitor contract performance and contract compliance.
Requirements
  • A bachelor's degree in healthcare administration or business is required; a master's degree is preferred.
  • A minimum of 5 years of related experience is required, commensurate with education.
  • Minimum of 5 years' of combined payor and provider experience is required.
  • Previous healthcare experience is required.
Preferred Qualifications
  • In-depth understanding of contract parameters, reimbursement methodologies, contract language, and performance.
  • Knowledge in Risk and Value-Based Contracting.
  • Effective strategic planning and organizational skills.
  • Knowledge of Statewide Medicaid Managed Care programs and Commercial payors.
  • Proficient in research, analysis, and interpretation of financial data and trends.
  • Knowledge of reimbursement methodologies and CPT, ICD10, RBRVS, and capitation.
  • Knowledge of claims, credentialing, and loading processes.
  • Advanced Microsoft Office skills.
  • Effective oral and written communication and negotiating skills.
  • Ability to manage multiple priorities and projects.
  • Strong interpersonal skills.
  • Ability to influence others.
Working Conditions
  • Non-patient facing.
  • May be either full-time remote or rotate working in the office.
  • Must be U.S.-based.
  • Indoor Work.
  • Operating Computer.
  • Reach Outward.
  • Reach above Shoulder.
  • Lift/Carry 11-20lbs.
  • Standing.
  • Sitting.
  • Traveling.
  • Walking.
  • Bending.
  • Manual Dexterity.
Performance Requirements

Adhere to all organizational information security policies and protect all sensitive information, including but not limited to ePHI and PHI, in accordance with organizational policy, Federal, State, and local regulations.

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