Advisor, Managed Care, Payer Relations

Cardinal Health

3d•$80,900 - $92,400

About The Position

Managed Care oversees the business and administrative operations of a medical practice. Managed Care oversees the interactions that take place between payer and provider(s) to ensure optimal reimbursement including managed care contracting, enrollment, credentialing, and any other activity as it relates to payer interaction. Payer Relations Manager is responsible for the oversight and administration of third-party payor contracts, exercising independent judgment and discretion in supporting contract negotiations, implementation, and ongoing compliance. This role manages the contract lifecycle, including single case agreements, contract documentation, fee schedule oversight, and the integrity of contract data within management systems. The Payer Relations Manager evaluates contract administration accuracy, identifies and leads corrective actions, monitors payor policy and reimbursement changes, and ensures timely communication of contract terms and requirements to internal stakeholders. Acting as a subject matter resource, the role supports operational teams, coordinates payor implementation activities, and contributes to organizational financial and operational objectives through effective payor relationship management.

Requirements

At least five (5) years of experience in a managed care contracting, working directly with managed care/third party contracts preferred
Specific knowledge of the payer environment and payer issues, particularly billing and collections preferred
Ability to work a flexible schedule (including overtime, and weekends), as necessary.
Analytical and computational skills
Excellent customer service and communication skills.
Ability to work independently and as part of a team.
Working experience with Excel spreadsheets and Microsoft Word documents.

Responsibilities

Assist with negotiating contracts with payors as directed
Negotiate single case agreements with non-contracted plans, Medicaid, Medicaid HMO plan and international
Manage contract management and maintenance ensuring systems are updated when contract terms change.
Communicate all details regarding contracts to the internal/external team.
Monitor the Managed Care email inbox ensuring proper action is taken.
Assists educating team(s) regarding new contract implementations, changes to existing contracts, cancelled contracts, payer requirements, new programs required by payers, etc.
Identify and lead the correction on any inaccurate administration of the contracts.
Assist in coordinating/monitoring third party payor implementation activities including acting as a resource for internal operations
Insure all new or renegotiated contracts or amendments and any supporting documents are updated on all resources in a timely basis
Oversee fee schedule loading and calculations
Assess the quality of the contract information entered into the contract management system
Maintain contract matrices outlining contract terms for third party payors
Provide business units with the tools necessary to effectively administer new contract terms and rates, changes in third party payor policies
Monitor and communicate payor changes to appropriate stakeholders.
Performs any other functions as required by management.