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Payer Relations Manager

Payer Relations Manager

Job ID 
2018-2006
Location 
US-TX-Dallas
Metro Area 
Dallas/Fort Worth, TX
Function 
Revenue Cycle Management
Employment Status 
Full-Time

More information about this job

Overview

U.S. Anesthesia Partners (USAP) is the largest single-specialty anesthesia practice in the country with over 4,000 clinical providers and associates.  By joining our team you will participate in a highly collaborative and dynamic environment.  As an organization we are mission focused on delivering the highest quality in patient care and you will be directly supporting our talented clinical team.  We extend this same commitment to quality to our associates and supply tools and resources that will ensure we win in the healthcare marketplace and support of USAP.

 

We are proud of our inclusive people culture that supports our associates to perform at their best.  USAP is an equal opportunity employer.  Candidates with physician services or related health care experience is a plus. We offer a competitive benefits package. 

 

The Payer Relations Manager is responsible for owning the payer relationships for USAP Texas contracts. The Payer Relations Manager will partner with the Payer Compliance Manager to ensure that over allowed and under allowed payments are reviewed by the payer and that correct next steps are taken. The Payer Relations Manager will also support the Accounts Receivable process to ensure systemic denials or payer lack of response is addressed with the payers. The Payer Relations Manager will help validate payer compliance management payment analysis, examining reimbursement compliance and (payment) variances to contracted reimbursement rates. This includes possessing in-depth contract knowledge.

Responsibilities

ESSENTIAL DUTIES AND RESPONSIBILITIES (include but not limited to):

  • Supports the USAP-TX Payer Compliance and A/R Managers 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.
  • Perform additional Managed Care Team functions as needed, including the follow:
    • Upon contract approval, notify Provider Enrollment of MCOs credentialing requirements;
    • Assist with development of contract summary to be dispersed to Provider Enrollment, Pain CBO and Anesthesia CBO;
    • Create fee schedules based on contract parameter and ensure timely loading in the billing system.
    • Update annual fee schedule in the billing system timely.
  • Contribute information necessary to support contract negotiations.
  • Provide recommendations to the Payer Compliance and Accounts Receivable Manager, USAP EVP Payer Contracting and USAP-TX 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.   
  • Others duties as assigned. 

JOB REQUIREMENTS (Knowledge, Skills and Abilities):

  • Proven experience working in a payer or provider relations role.
  • 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.
  • Proficient in Medical Terminology.
  • Strong leadership qualities and problem-solving skills.
  • Must have the ability to work with limited direct supervision.
  • Ability to read, write, and speak English.

Qualifications

EDUCATION/TRAINING/EXPERIENCE:

  • High School diploma or equivalent required. College degree is strongly preferred. Will consider work experience equivalent.
  • Five years of experience working in a payer or provider relations role.
  • Minimum 3 years middle management experience or higher.

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