Payor Operations Coordinator

Texas Health Resources•Arlington, TX

22h•Hybrid

About The Position

The Payor Operations Coordinator plays a crucial role in managing and implementing payor contracts, ensuring alignment between revenue cycle operations and strategic initiatives. This hybrid position offers a collaborative environment with excellent mentorship and leadership support. The coordinator will be responsible for contract management, including maintaining a database of contractual terms, interpreting contract provisions, and analyzing reimbursement trends. They will also coordinate contract implementation with various internal departments and external entities like SWHR and Payors. Additionally, the role involves monitoring payor policy updates, regulatory changes, and compliance requirements, recommending procedural improvements, and participating in the development of departmental documentation. Administrative duties include preparing meeting agendas, maintaining minutes, assisting with reports and analytics, and coordinating provider credentialing and demographic data.

Requirements

Bachelor's Degree Business, Healthcare, or related field Req
4 Years Experience in managed care, provider relations, payor relations, revenue cycle management, health care or related field Req
Excellent organizational skills, verbal and written communication skills required.
Ability to collaborate with cross-functional teams.
Proficiency with Microsoft Office applications.
Understanding of contract provisions, healthcare reimbursement methodologies, payor policy structures, regulations and compliance requirements across hospital, ancillary provider and physicians.
Ability to manage multiple deadlines and escalate issues appropriately.
Reliable transportation for meetings and travel as needed.

Nice To Haves

2 Years Experience in multi-entity hospital systems or value-based program environments. Pref
Understanding of contract provisions, healthcare reimbursement methodologies, payor policy structures, regulations and compliance requirements across hospital, ancillary provider and physicians. Preferred

Responsibilities

Collaborate with revenue cycle operations, finance and clinical terms to align payor strategies with operational initiatives.
Assist in developing and maintaining a comprehensive database of contractual terms and rates for all Texas Health providers, inventory and archiving contracts.
Exercise independent judgment in interpreting contract terms and determining appropriate alternatives for operational application.
Review and assess reimbursement trends, denials, and payment discrepancies to identify root causes, and recommend corrective actions.
Coordinate communication with the final contract terms to internal stakeholders (i.e. Patient Access, Revenue Cycle, Medical Management, Contract Management, Finance, Facilities, Ancillary Providers, Physicians).
Coordinate contract implementation with the business office and ITS to ensure the contracts are loaded per the intent and work with SWHR and Payors on contract interpretation issues.
Coordinate communication with other departments/entities on payor activity and new contracts through the system.
Gather, log, and monitor escalated payor-related issues from internal departments. Analyze, coordinate and combine reimbursement trends, denials and payment discrepancies to identify root cause/trends and areas for improvement.
Prepare and present analytical reports and recommendations regarding payor performance, contract compliance, and reimbursement risk to leadership and cross-functional stakeholders.
Develop and maintain ongoing collaborations and partnerships with SWHR and Payors and serve as the interface with SWHR and Payors for operational, financial and contract compliance issues.
Track, document and monitor payor policy updates to identify any operational and financial impact. Route contract-related issues to internal teams and SWHR as appropriate.
Monitor payor policy updates and regulatory changes and share impacts with internal stakeholders.
Support Contract Analyst by assisting with validation of rate loads, reimbursement discrepancies, and transparency requirements.
Recommend procedural or workflow changes to address compliance risks, reimbursement exposure, or audit findings related to payor policies and regulatory requirements.
Participate in development and maintenance of departmental guidance, documentation, and procedural standards related to payor operations.
Prepare agendas and maintain accurate minutes for internal meetings, payor meetings, and cross-functional workgroups synthesizing complex payor information into actionable steps.
Assist with reports, dashboards, and analytics to support contract performance and operational insights.
Coordinate and support SWHR with Centers of Excellence (COE) surveys and related documentation.
Assist with the credentialing and recredentialling process for healthcare providers.
Coordinate requests for provider demographic data in a centralized location and update master provider demographic data for facilities, ancillary providers and physicians. Determine appropriate points of contact for information.
Other projects/ duties as assigned.