Payer Contracting Specialist
2 days ago
The Payer Contracting Specialist will partner with the Manager of Contracting and Payor Relations to implement payor strategy, focusing on payor operations, client services, and process improvement. This role will ensure resolution of payor issues, tracking of opportunities, and continual documentation and improvement of processes.
This position requires onsite work in our Northbrook, Illinois corporate office. Remote work is not an option.
Key Responsibilities- Negotiate managed care agreements with payors, health systems, IPA's, and other entities, including language and rate negotiation.
- Develop working knowledge of various reimbursement strategies and analyze rate proposals.
- Identify unfavorable contract language in agreements.
- Assist with implementation of payor strategy in partnership with the Manager of Contracting and Payor Relations.
- Maintain operational knowledge of contractual agreements and specific contractual language with Payors.
- Coordinate with credentialing regarding demographic updates and needs related to contracting efforts.
- Collaborate with Operations, legal, billing, and compliance to track and resolve payor issues, including payment and/or billing disputes.
- Develop and improve processes to provide clear communication throughout the lifecycle of contracting efforts.
- Determine and implement tools or technology required to assist in providing communication and updates to leadership and other relevant stakeholders.
- Manage contract assignments and documentation relevant to negotiation, strategy, and/or implementation of the contract.
- Proactively monitor and report current contracting efforts.
- Partner with internal team to ensure contracting efforts align with company and divisional goals.
- Communicate with relevant stakeholders to ensure contract commitments are operationalized.
- Bachelor's degree, Required
- At least 1-3 years managed care contracting experience, preferably with a provider, Required
- Prior healthcare provider or health plan contracting, contract operations, service operations, or provider relations experience, Required.
- Health insurance with dental and vision
- PTO with sick time
- 401k & match
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