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Payer Contracting Specialist
2 months ago
We are seeking a highly motivated and detail-oriented Payer Contracting Associate to join our team at USA Clinics Group. As a key member of our contracting team, you will play a critical role in implementing payor strategy, focusing on payor operations, client services, and process improvement.
Key Responsibilities- Assist with negotiation of managed care agreements with payors, health systems, IPA's and other entities, including language and rate negotiation.
- Gain working knowledge of various reimbursement strategies and ability to analyze rate proposals.
- Develop ability to identify unfavorable contract language in agreements.
- Assist with implementation of payor strategy in partnership with the Manager of Contracting and Payor Relations.
- Maintains a thorough operational knowledge of contractual agreements and specific contractual language with Payors.
- Coordinate with credentialing regarding demographic updates and needs related to contracting efforts.
- Collaborates with Operations, legal, billing, and compliance to track and resolve payor issues, including payment and/or billing disputes.
- Continually create, document, and improve processes to provide clear communication throughout the lifecycle of contracting efforts.
- Manages contract assignments and any documentation relevant to the negotiation, strategy, and/or implementation of the contract.
- Proactively monitor and report on current contracting efforts.
- Partner with internal team to ensure that contracting efforts align with company and divisional goals.
- Communicate with relevant stakeholders to ensure contract commitments are operationalized.
- Bachelor's degree, Required
- Degree in Health Care Administration, Managed Care Contracting or similar degree Preferred
- Interest in Health Care operations Required
- Health insurance with dental and vision
- PTO with sick time
- 401k & match
