Payor Contracting Manager
The Payor Contracting Manager will be responsible for all contract administration, contract verification, and customer support for Proliance Care Centers. This position will work directly with the payor representatives to resolve payment issues and disputes. Position will manage 1 FTE.
This position reports to the Director of Analytics and Payor Contracting.
- Manage but work alongside with as well, our payor contracting specialist. Position will divide and prioritize the workload of incoming requests from care centers.
- Propose contract rates, structures and terms internally. Communicate terms with payors
- Hold quarterly payor meetings, as well as training sessions on various topics with our care centers
- Maintain Proliance Insurance Manual regarding contract status and referral/auth requirements
- Manage and monitor accuracy of Experian, a contract management tool.
- Using Excel, Access, or other data analysis tools, develops analyses to support decision making.
- Acts as liaison between corporate and care centers for reimbursement and payer contracting issues.
- Maintains a working knowledge of applicable Federal and State reimbursement laws and regulations as well as payor payment policies and procedures.
- Identifies changes in regulations and payor policies on a timely basis, identifies the contracts impacted and related financial impact. Communicates changes to care centers.
- Interprets contracts, models the fee schedule, loads the fee schedule into our EMR
- Compiles and maintains charge master
- Monitors any monthly, quarterly, or yearly changes to CMS fee schedules, calculates the impact to each contract, updates the fee schedules accordingly.
- Reviews claim payments to ensure contract implementations are correct, monitors’ compliance with contractual terms.
- Coordinate with IT and Rev Cycle on special projects and process improvement.
- Attends and participates in internal and client meetings as needed.
- Engages in process and quality improvement activities to minimize manual efforts.
- Performs other duties as required by management.
- Bachelor’s degree or greater in Finance, Accounting, Business Administration, Healthcare Management, or related field.
- MBA/MHA preferred.
- Minimum of 5 years’ experience working in payor contracting. 10+ years preferred.
- Experience working in physician practices, hospitals, or ASC’s.
Skills/Professional and Personal Qualities
- Knowledge of coding conventions i.e. (Revenue Codes, Occurrence Codes, ICD-9, ICD-10, CPT and HCPCS codes).
- Knowledge of the various types of health insurance payers: Medicare, Medicare Advantage Plans, Commercial, Medicaid, and Medicaid Managed Care, L&I, Workers Comp.
- Broad ranging knowledge of ASC’s, Clinics, and Ancillary Services.
- Knowledge of healthcare reimbursement methodologies, contract language.
- Understands the fundamentals of billing.
- Strong analytical skills and familiarity with common data analytics tools including Excel, Access, or other analytics tools. Experience with Business Intelligence tools would be a plus.
- Ability to communicate effectively using data with all levels of the organization.
- Self-motivated team player able to multi-task and prioritize.
- Ability to work independently, multi-task,
- Email cover letter and resume to Eliese Georges at email@example.com
- Use “Payor Contracting Manager” as the subject.
- Applicants under consideration will be scheduled for a phone interview. Successful first round candidates will be invited to interview in person.
We regret we are not in position to personally respond to all applicants.
About Proliance Surgeons
Proliance Surgeons is one of the largest surgical practices in the country, with 200 board-certified physicians providing treatment at more than 60 care centers in Washington State. Our range of specialties includes orthopaedics, sports medicine, ear nose & throat, general surgery, ophthalmology, urology and more. Many of our surgeries are performed at our own outpatient surgery centers - where costs are often lower and recovery times faster than at a hospital. Patients return home the day of their surgery to begin healing and rehabilitation and get back to doing what they love, faster. Proliance physicians helped more than 600,000 patients last year alone, and performed over 77,000 surgeries. See www.proliancesurgeons.com for more information about our practice.