Manager of Payor Relations

3 days ago

Baton Rouge, LA, United States FMOL Health Full time

Responsible for the financial pricing and analysis of all governmental and commercial insurance contracts for FMOLHS facilities and all affiliated entities. Works collaboratively with Revenue Cycle, Revenue Management, Business Office, Medical Management and operational departments to ensure the accuracy of payment data, the optimization of reimbursements and the implementation and administration of all managed care contracts.

Financial Analyst Function

  • Develops and maintains financial information related to volume, financial performance and profitability for each managed care contract for all FMOLHS affiliated entities. Extracts and analyzes historical data to help direct reimbursement strategies.
  • Responsible for updating and maintaining the Contract Management module of the cost accounting system to ensure accurate financial reporting and analysis of payor data.
  • Works with all FMOLHS affiliated entities and their information systems to identify revenue enhancement opportunities and to quantify the financial impact of changes to contract reimbursements.
  • Facilitates the operational process of managed care contracts by working with internal and external stakeholders to ensure policies and procedures are followed by hospital personnel in a manner that facilitates high quality patient care and accurate reporting.
  • Assists Corporate Director of Payor Relations with contract negotiations for FMOLHS hospital and affiliated entities.
  • Possesses the ability to resolve day-to-day managed care operational issues with contracted payers and serves as a liaison to FMOLHS hospitals and medical staff to provide continuous communication in regards to managed care contracts, plans and products.
  • Responsible for benchmarking payment rates and cost to other hospitals, surgery centers, clinics or health systems.
  • Analyzes and prepares clinical and financial data in requested operational service lines.
  • Serves as the financial analyst in the supporting of partnerships and joint venture arrangements
  • Strives to promote the quality and efficiency of his/her own performance by remaining current with the latest trends in field of expertise through participation in job-relevant seminars and workshops, attendance at professional conferences, and affiliations with national and state professional organizations.

Job Requirements

  • 5 years Hospital, Physician Office or Managed Care Experience
  • Bachelor's Degree
  • Strong Math and Logic Skills
  • Reimbursement methodology skills a plus
  • Preferred: EPIC Certifications must be obtained within 12 months of employment. Resolute Professional Billing Reimbursement Contracts and Resolute Hospital Billing Expected Reimbursement Contracts Administration.

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