Payer Relations Representative

3 weeks ago

Aurora, United States Children's Hospital Colorado Full time

Job ID85741 LocationAurora, Colorado Full/Part TimeFull-Time Regular/TemporaryRegular Why Work at Children's.... Here, it's different. Come join us. Children's Hospital Colorado has defined and delivered pediatric healthcare excellence for more than 100 years. Here, the nation's brightest nurses, physicians, scientists, researchers, therapists, and care providers are creating the future of child health. With an optimist's outlook, a trailblazing spirit, and a celebrated history, we're making new strides every day. We've been Magnet-designated four times by the American Nurses Credentialing Center and are consistently recognized among the best of the best pediatric hospitals with #1 rankings in Colorado and the region by U.S. News & World Report. As a national leader in pediatric care, we serve children and families from all over the nation. Our System of Care includes four pediatric hospitals, 11 specialty care centers, 1,300+ outreach clinics and more than 10,000 healthcare professionals representing the full spectrum of pediatric care specialties. Here, we know it takes all of us, every role, to deliver the best possible care to each child and family we treat. That's why we build our teams toward a foundation of equity in access, advancement, and opportunity. We know teams of individuals with different identities and backgrounds can nurture creativity and innovation. We know we can see, treat, and heal children better when our team reflects the diversity of our patient population. We strive to attract and retain diverse talent because we know a truly inclusive and equitable workforce will help us one day realize our most basic calling: to heal every child who comes through o A career at Children's Colorado will challenge you, inspire you, and motivate you to make a difference in the life of a child. Here, it's different. Job Overview The Payer Relations Representative is the primary resource for internal and external customers insuring overall contract implementation and compliance for Children's Colorado. The Payer Relations Representative works directly with contractors and networks teams by ensuring that contracts are correctly implemented for operational compliance. Additional Information Department Name:Managed Care Job Status: Full time, 40 hours per week. Shift: Monday to Friday 8am to 5pm, Hybrid Qualifications EDUCATION - Bachelor's degree. EXPERIENCE - 3 years Payer Relations, Network Management, Contracting, or similar background. EQUIVALENCY - Related work experience may substitute for education requirements on a year for year basis. Responsibilities POPULATION SPECIFIC CARE No direct patient care. ESSENTIAL FUNCTIONS An employee in this position may be called upon to do any or all the following essential functions. These examples do not include all the functions which the employee may be expected to perform. Develops and distributes educational materials and communications. Conducts in-services for internal departments, staff and network members regarding contract provisions by applying and interpreting knowledge of contractual terms Schedules, prepares and conducts standardized monthly, quarterly and ad-hoc meetings with both network members, and multiple organizations to address problems and/or issues through resolution. Participate in payer forums as necessary. Analyzes complex payer information and reports, including updated payer policies or procedures, to provide accurate in-depth analysis and timely recommendations or communications to key individuals and leadership as well as third parties. Maintains and updates an effective tracking system of all payer credentialing materials as required for payer contracts. Facilitates the dissemination of monthly rosters. Independently resolves issues between parties, organizations or providers. Determines action required to resolve problems or issues and coordinates wi h other departments as needed to ensure resolution. Develops communication strategy for providing timely and accurate information on payer policies and procedures as well as processes on a regularly scheduled basis. Participates in the initial orientation of newly contracted services related to payer contracts and their requirements. Implements processes to ensure adherence to protocols established by Children's Colorado or other institutions. Participates in and supports initiatives and shares expertise and bandwidth throughout the system as required. Functions as liaison between institutions and organizations assisting with problem solving and resolutions. Operates as a subject matter expert, whose expertise is relied on by... For full info follow application link.

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