Payor Operations Coordinator

#REF!•Arlington, TX

2d•Hybrid

About The Position

The Payor Operations Coordinator plays a crucial role in managing contracts, ensuring compliance, and coordinating operations related to payors within the Texas Health system. This position involves collaborating with various internal departments and external partners to align payor strategies with operational initiatives, interpret contract terms, and address reimbursement trends and discrepancies. The coordinator will also monitor policy updates, regulatory changes, and assist with administrative tasks to support departmental functions and ensure smooth operations.

Requirements

Bachelor's Degree Business, Healthcare, or related field
4 Years Experience in managed care, provider relations, payor relations, revenue cycle management, health care or related field
Excellent organizational skills
Verbal and written communication skills required
Ability to collaborate with cross-functional teams
Proficiency with Microsoft Office applications
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
Understanding of contract provisions, healthcare reimbursement methodologies, payor policy structures, regulations and compliance requirements across hospital, ancillary provider and physicians

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.