Payor Payment Integrity Consultant

Job Summary
Novant Health Business Development & Sales team develops strategies, negotiates, and maintains over $10B annual operating revenue from commercial, Medicare Advantage and Managed Medicaid, contracts across all Novant Health markets. The current portfolio also includes value-based arrangements with virtually every form of payment model from shared savings to full risk, including a large and growing episode of care strategy. Business Development & Sales is responsible for all managed care payor negotiations for all Novant Health locations and providers, including more than 19 facilities, over 2,000 professionals, and multiple imaging centers. The department also collaborates with revenue cycle teams on revenue recovery and retention. The Consultant, Payor Payment Integrity will be involved in a growing portfolio of strategic business relationship strategies and transactions including potential joint venture plans and provider discussions.

Business Development & Sales responsibilities are constantly evolving and currently represent key components of Novant Health's strategic imperatives. The Consultant, Payor Payment Integrity will be integral to the Revenue & Relationship Management team, which focuses on multi-state payor contracting and negotiation, relationship management, payor policy management, revenue retention initiatives, and corporate projects intersecting payor and provider revenue streams.

As such, the Consultant, Payor Payment Integrity will analyze and aid in the development of strategies for fee-for-service contracts in collaboration with revenue cycle teams to enhance revenue recovery and revenue retention. The Consultant, Payor Payment Integrity will also engage in strategic business relationships, including joint ventures and provider partnerships, to enhance opportunities to retain revenue. The Consultant, Payor Payment Integrity will maintain an understanding of key contract terms, payor policies and state and federal policies to monitor payment integrity and respond to internal inquiries. The Consultant, Payor Payment Integrity will have experience in working collaboratively with managed care payors, a strong understanding of fee-for-service contracts, excellent relationship management and communication skills, and the ability to collaborate effectively with cross-functional teams.

Responsibilities

• Build and maintain knowledge of regulatory policies and commercial payor policies
• Gather data and interpreting detailed analytics around contract negotiations and performance management
• Facilitate revenue recovery projects and identify revenue retention opportunities
• Refresh and manage existing reports to ensure data are current and accurate
• Develop tools to leverage and support effective decision making in payor contracting and negotiation approach
• Refresh and manage existing reports to ensure data are current and accurate
• Manage escalations from revenue cycle services, internal departments, or partners to the contracting leaders, ensuring timely, efficient, and effective resolution

Qualifications

• Education: 4 Year / Bachelors Degree, required. Bachelor's degree in healthcare administration, business, finance or healthcare related field

• Experience:

• Three years experience in managed care and payor contracting or related healthcare experience will be considered, required.

• Five years knowledge of healthcare payor contracts and policies, required.
• Experience in managed care contracting or payor operations, preferred.
• Proficiency in using contract management software and tools, preferred.
• Experience with using, managing, and interpreting large amounts of data, required.

Job Opening ID
118549