Payor Contracting Specialist Part Time

4 weeks ago

Houston, Texas, United States MOODY NEURO REHABILITATION INSTITUTE Full time
Job Details

Job Location: Moody Neuro Corporate - Houston, TX

Position Type: PRN (As Needed)

Education Level: 4 Year Degree

Travel Percentage: Negligible

Job Shift: Day

Job Category: Business Development

Description

The Payor Contracting Specialist will support payor contracting for our Lubbock, Houston, and Galveston facilities. This role requires a comprehensive understanding of healthcare regulations, preferably for assisted living facilities, and the ability to support contracting processes between payors and Moody Neuro. The Payor Contracting Specialist will collaborate with various stakeholders to ensure that all contracts are aligned with organizational goals and objectives.

Essential Functions

  • Evaluate current payor contracts and rates:
    • Perform initial review of payor contracts and propose changes, ensuring that information is readily available to Moody Neuro stakeholders by all appropriate means, including hardcopy and electronic.
    • Facilitate contracting process from initiation through closure, including preparing contract amendments, extensions, and terminations as needed.
    • Work with Moody Neuro stakeholders on reviewing proposed rates and ensuring that contract billing requirements are communicated and monitored.
  • Establish new payor contracting contacts and draft proposals:
    • Review market information and determine other potential payor sources, both locally and nationally, and related contacts.
    • Review Salesforce metrics to identify contracting opportunities.
    • Establish a format template to review with stakeholders on any new payor contracts or changes to current payor contracts.
  • Maintain accurate and up-to-date contract records and documentation:
    • Develop dashboards to assist in monitoring contract performance, compliance, and renewal dates to ensure timely actions are accurately taken.

Minimum Qualifications

  • Required Knowledge, Skills, and Abilities:
    • Knowledge of rehab services and contracting parameters.
    • Ability to prioritize and organize with minimum supervision.
    • Knowledge of Microsoft Windows, Office 365.
    • Excellent verbal and written communication skills.
    • Experience with CRM and billing software, including but not limited to reporting capabilities and data relevant to payor contract management.
    • Ability to track and report activities.
    • Very skilled with technology required for information management and exchange, including computers, smartphones, fax machines, search engines, contact management systems, etc.

Qualifications

  • Education:
    • Bachelor's Degree from an accredited college or university preferred.
    • In-depth knowledge of healthcare regulations, including HIPAA, Stark Law, and Anti-Kickback Statute.
  • Experience:
    • 6+ years' experience working in a high-level administrative support position. 2+ years working in a medical group, health plan, hospital, or other related healthcare organization.
    • Proven track record of successful contract analysis and administration preferred.

Demands and Characteristics of Work, Equipment Usage, and Work Environment

  • Percentage of Work Time (1-10%):
    • Twisting.
    • Climbing (Ascending/Descending).
    • Working with hazardous waste materials.
    • Utilizing essential upgraded or adaptive equipment as industry standards require.
    • Using hand tools.
    • Potential for cuts and bruises.
  • Percentage of Work Time (34-66%):
    • Sitting.
    • Pushing/Pulling.
  • Percentage of Work Time (10-20%):
    • Standing/Walking.
    • Operating vehicle.
  • Lifting Requirements - individuals in administrative positions are required to lift minimal supplies (1-33%):
    • 2 - 10 Pounds.
  • Does this job require? (1-10%):
    • Working with or near chemicals.
  • Does this job require? (10%):
    • Working outdoors.
  • Exchange of Ideas %):
    • Ability to express or exchange ideas.
    • Ability to understand communication of others with or without adaptive devices.
    • Obtaining impressions through the eyes of the shape, size, distance, motion, color, or other characteristics of objects with or without adaptive devices. The major visual functions are:
      • Acuity, far - clarity of vision at 20 feet or more.
      • Acuity, near - clarity of vision at 20 inches or less.
      • Depth perception - three-dimensional vision. The ability to judge distance and space relationships so as to see objects where and as they actually are.
      • Field of vision - the area that can be seen up and down or to the right or left while the eyes are fixed on a given point.
      • Accommodation - adjustment of the lens of the eye to bring an object into sharp focus. This item is especially important when doing near-point work at varying distances from the eye.
      • Color vision - the ability to identify and distinguish colors.
    • Regular Attendance.
    • Punctuality.
    • Ability to do Math.
    • Literate.

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