Payor Relations Specialist - CHOPPA
About The Position
The Payor Relations Specialist supports the Reimbursement Strategy and Contracting Department by helping the health system understand and comply with payor contracts, improve revenue streams, reduce administrative barriers, and address other managed-care issues. The role coordinates with departmental and divisional leaders to identify unresolved issues and escalate them to payors after the relevant CHOP entity has exhausted its leverage. The specialist serves as an enterprise resource for payor contracts, policies, guidelines, new-plan information, and other payor-market intelligence. The position also supports contract interpretation and education, identifies opportunities related to new payor agreements, organizes contract implementation and termination processes, and contributes to contract analysis, negotiation support, and Legal review. In collaboration with Access and Revenue Cycle teams, the specialist works to identify and reduce access and revenue-cycle barriers.
Requirements
- Bachelor's degree.
- At least seven years of industry- and topic-related experience.
- Strong understanding of the local managed-care environment, including managed-care policies and procedures, payment models, and managed-care models.
- Excellent communication skills and demonstrated organizational skills, with the ability to multitask.
- Strong interpersonal skills; organized and detail-oriented.
- Ability to work independently, achieve specific goals and objectives, and recommend improvements.
- Ability to collaborate with a strong orientation toward bottom-line results.
- Excellent written and oral presentation skills.
- Strong working knowledge of EPIC and Microsoft Office applications.
- Ability to work with large, diverse data sets and summarize them as meaningful, presentable, and actionable information.
- Ability to interpret complex and comprehensive managed-care information.
Responsibilities
- Serve as an enterprise source of information about payor contracts, policies, guidelines, new-plan information, and other relevant payor-market intelligence.
- Provide monthly updates on payor policies and procedures across the health system.
- Interact with individuals throughout the organization in a professional, customer-focused manner.
- Provide contract interpretation support and education for the health system.
- Identify operational and financial opportunities associated with new payor agreements.
- Organize and lead contract implementation, including completion of new agreements and contract terminations.
- Participate with Reimbursement Strategy and Contracting leaders in analyzing new and renewal payor contracts.
- Track contracts and prepare business perspectives for Legal review.
- Support contract negotiations as required.
- Serve as the primary payor contact for contractual rate changes for PFS-P to the Manager of Revenue Analytics.
- Work with Access and Revenue Cycle teams to identify and remove or reduce access and revenue-cycle barriers.
- Coordinate with departmental and divisional leadership to identify unresolved managed-care issues and escalate them to payors when appropriate.
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What This Job Offers
Job Type
Full-time
