Payer Relations Coordinator-Full Time-Days

Cape Fear Valley Health

2d•Onsite

About The Position

Assist in developing, implementing and maintaining contractual relationships as well as take lead on other projects. The following is a summary of the major essential functions of this job. The incumbent may perform other duties, both major and minor, that are not mentioned below. In addition, specific functions may change from time to time:

Requirements

High school diploma or equivalent required
Proficiency in reading, writing, and speaking the English language
Proficiency with personal computer, electronic calculator, fax machine and copy machine
Excellent interpersonal skills with the ability to interact with hospital management, physicians and outside organizations
Ability to be effective with little to no day-to-day supervision
Possess and demonstrate strong written and verbal skills, be results oriented, and exemplify a team player attitude
Strong analytical and financial skills to determine the potential economic impact of relationships, contracts and contract alternatives
Ability to demonstrate effective leadership traits and competently execute decisions
Ability and willingness to work on a variety of activities and projects
Ability to work with people in a tactful, diplomatic manner

Nice To Haves

Bachelor’s degree preferred OR 8 years of experience preferred
3 years medical business experience in a related field or managed health care experience preferred
Experience working directly with employers, insurance companies and/or physicians is strongly preferred

Responsibilities

Assist and, in some cases, lead negotiating and maintaining managed care contracts
Coordinate reporting that analyze reimbursement methodologies and rates to determine payment accuracy
Assist in developing, implementing and maintaining a system of renewal and reporting to monitor the status, performance and viability of contracts
Work with internal and external stakeholders to ensure appropriate and timely loading of contract changes
Monitor Managed Care websites for any change in policy
Work with PFS to determine appropriate claims for escalation
Work with Payers on appeals of denial
Maintain, monitor and report on managed care recoupment activities
Work with Client billing lists to ensure contracts are being reimbursed
Maintain and validate third-party commercial refund requests
Other duties as assigned