Payer Contracting Specialist

1 week ago


Northbrook, Ohio, United States USA Clinics Group Full time
Job Overview

The USA Clinics Group is seeking a highly motivated and detail-oriented Payer Contracting Associate to join our team in Northbrook, Illinois.

About the Role

  • This entry-level position focuses on network development, contracting, and process improvement.
  • You will partner with the Manager of Contracting and Payor Relations to implement payor strategy and resolve payor issues.

Responsibilities

  1. Assist with negotiation of managed care agreements with payors, health systems, IPA's, and other entities, including language and rate negotiation.
  2. Gain working knowledge of various reimbursement strategies and ability to analyze rate proposals.
  3. Develop ability to identify unfavorable contract language in agreements.
  4. Implement payor strategy in partnership with the Manager of Contracting and Payor Relations.
  5. Maintains a thorough operational knowledge of contractual agreements and specific contractual language with Payors.
  6. Coordinate with credentialing regarding demographic updates and needs related to contracting efforts.
  7. Collaborate with Operations, legal, billing, and compliance to track and resolve payor issues, including payment and/or billing disputes.
  8. Continually create, document, and improve processes to provide clear communication throughout the lifecycle of contracting efforts.
  9. Manage contract assignments and any documentation relevant to the negotiation, strategy, and/or implementation of the contract.
  10. Proactively monitor and report on current contracting efforts.
  11. Partner with internal team to ensure that contracting efforts align with company and divisional goals.
  12. Communicate with relevant stakeholders to ensure contract commitments are operationalized.
  13. Additional duties as assigned.

Requirements

  • Bachelor's degree, required.
  • Degree in Health Care Administration, Managed Care Contracting, or similar degree preferred.
  • Interest in Health Care operations required.

Benefits

  • Health insurance with dental and vision.
  • PTO with sick time.
  • 401k & match.


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