Payer Relations Specialist - Pilot
About The Position
The Payer Relations Specialist assists with the administrative oversight of payer contracts on behalf of ROMTherapy. Works closely with Payer Relations Management to maintain the details of participating network contracts, assist in acquisition of new Payer contracts and supports the Payer Relations Team in responding to Single Case Agreements and in tracking outcomes of all Payer Relations contracts communications and activity. Provides internal support and general assistance and support to the Director of Managed Care, Payer Relations Management and ROMTherapy Credentialing resources. Reports to the Director of Managed Care
Requirements
- Associates Degree in business, healthcare administration, or equivalent experience is required.
- Conceptual knowledge of principles and practices of healthcare related payer relations/contracts.
- Strong communication skills and ability to interface with Payer Provider Relations Reps
- Ability to manage multiple tasks and work in a fast-paced environment is required.
- Detail oriented and able to deliver a high level of accuracy.
- Proficient in all MS Office applications, including Excel, Access, PowerPoint and Word.
- Ability to define problems, collect data, establish facts, and draw valid conclusions.
Nice To Haves
- Bachelors degree is preferred and up to 3 years of Payer Relations experience is desired.
Responsibilities
- Collaborates directly with the Director of Managed Care and Payer Relations Management to support all payer relations business needs.
- Possess in-depth knowledge and understanding of payer's guidelines, contractual terms, and the processing of ROMTherapy claims to provide direction and guidance to all internal departments.
- Responds to payer contract questions as well as benefit and billing questions
- Coordinates with revenue cycle, and credentialing teams to ensure that all payer contractual obligations are met.
- Rectifies day to day issues for provider service representatives and others within practice operations
- Maintains relationships with provider relations representatives with all contracted managed care plans.
- Identifies issues to discuss in recurring payer meetings.
- Provides verbal and written communication to all applicable ROMTherapy practice operations, ancillary, and billing teams related to updates of payer information such as payer provider manuals, provider bulletins and other notices relating to eligibility, covered services, pre-authorization requirements, coding and claim requirements, appeal processes, etc.
- Analyzes and coordinates execution of single case agreements and requested contracts including communications with other teams.
- Responds promptly to client needs and solicit feedback to improve service, meet commitments and provide follow-up within a timely manner.
- Develops training aids and trains staff on the use of online portals and other tools utilized to obtain prior authorizations in compliance with all payer plans to maximize efficiency
- Provides excellent customer service and adhere to ROMTherapy's Code of Conduct and Ethics Standards.
- Performs other job duties as assigned.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
Associate degree
