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Payer Relations Manager

Payer Relations Manager

Job ID 
2017-1569
Location 
US-FL-Maitland
Function 
Legal/Compliance
Employment Status 
Full-Time

More information about this job

Overview

We are looking for a Payer Relations Program Manager to support the JLR clinical practices and USAP’s EVP, Payer Contracting with an exceptionally strong work ethic and customer service orientation on key matters strategic and operational matters associated with managed care contracting.

 

Responsibilities

Position Description:

 

Manages the operational relationships with contracted managed care organizations (MCOs) by:

  • Reporting, formulating, and implementing processes and projects to positively influence established contract performance metrics;
  • Eliminating operational defects;
  • Simplifying contract administration;
  • Providing a supporting role in monitoring, evaluating and appropriately communicating changes in MCO payment terms, and/or administrative or payment policies; and
  • Helping to assure JLR and its affiliated practice relationships with each MCO remains respectful and positive.

Acts as the primary point of contact for each contracted MCO on all matters related to contract administration.

Conducts and coordinates routinely scheduled, face-to-face, meetings with select high-profile and/or high-volume MCOs on behalf of JLR to support and enhance the operational relationship between the MCO and JLR and each JLR affiliated practice.

Contributes information necessary to support contract negotiations.

Maintains managed care contract files, including entry and maintenance of the USAP contracts database.

Provides recommendations to the USAP EVP Payer Contracting and JLR affiliated practice senior leaders and business managers on matters related to improving MCO contract terms and identifying payers for both new contracts and contract remediation.

Other duties as assigned

Qualifications

Job Requirements:

Five years of experience working in a payer or provider relations role, with demonstrated experience in successfully operationalizing and administering managed care contracts and payer relationships.  Must be able to manage multiple projects simultaneously in a highly-matrixed organization, have an exceptionally strong customer service focus, and superb organizational and communication skills.  College degree is strongly preferred, but not required

 

Services Provided:

Participates in USAP supported committees to ensure consistent information flow and adequate communication to all necessary entities.

 

Maintains the strict confidentiality required for medical records, other data and contracts.

 

Participates in professional development efforts to ensure currency in managed care reimbursement and operational trends.

 

Work Relationships:

Works closely with USAP’s EVP Payer Contracting, the JLR senior practice leadership, payer representatives, and practice managers to foster and maintain expected high levels of customer service and cooperation and to assist in achieving each practice’s financial and operational objectives. 

 

Computer Skills:

Microsoft Office products, particularly, Microsoft Word, Microsoft Excel and Microsoft PowerPoint applications, various revenue cycle and credentialing applications and their associated reporting systems

 

Travel:

25% (local)

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