Payor Partnerships Administrator (Lab)

DaVita Kidney Care

2d • Onsite

About The Position

The Administrator, Payer Partnerships (Lab) read, interpret and administer the terms of the contract portfolio that health insurance companies have in place with DaVita Labs and DaVita Kidney Care to ensure contractual terms are accurately reflected in the billing system. This position manages relationships with a wide variety of payors, within these relationships, this position is responsible for securing and maintaining in-network status through credentialing, contract negotiation and implementing payor contracts. This position performs surveillance of all federal and state laws and regulations pertaining to the reimbursement of clinical laboratory services to ensure compliant billing practices. This position reports to the Manager, Payor Partnerships (Lab)

Requirements

• Legal language
• Contract Interpretation
• Contract Negotiation
• Credentialing
• Knowledge of provider and payer relationship
• Knowledge of Revenue Operations in Health Care
• Knowledge of rules and regulations around Government entities such as CMS
• Intermediate computer skills and proficiency in MS Word, Excel, Outlook, and ability to use Internet effectively required

Responsibilities

• Complete and monitor provider credentialing applications, negotiate payer contracts and single patient agreements on behalf of the lab.
• Process payer correspondences and complete monitoring of rules and regulations from Governmental entities with the use of MediRegs and various sources
• Read and interpret new, amended, renegotiated payer contracts and single patient agreements in preparation for system implementation
• Coordinate with Lab Finance Systems and Lab Billing to setup payers in the billing system
• Coordinates with Lab ROPS and DKC Payor Partnerships teammates as needed to resolve contract issues
• Analyze fee schedule changes for loading into the system
• Address and resolve interface deficiencies
• Perform payer analytics and identify trends through root cause analysis including review of newly established contracts to ensure accuracy in billing and reimbursement
• Provide recommendations and redlines to Payor Partnerships (DKC) for lab terms within proposed contracts
• Coordinate with Payor Partnerships (DKC) to trouble shoot problematic payers, address contractual discrepancies, language impact, and perform necessary financial impact analytics
• Add facilities and products to existing contracts and terminate from existing contracts

Benefits

• Medical, dental, vision, 401(k) match, paid time off, PTO cash out
• Family resources, EAP counseling sessions, access Headspace®, backup child and elder care, maternity/paternity leave and more
• Professional development programs
• On-demand virtual leadership and development courses through DaVita’s online training platform Star Learning

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed