Title: Manager of Payer Relations
Location: Newport Beach, CA; Dallas, TX, or Nashville, TN
Overview: The Manager of Payer Relations serves as the primary relationship manager for Physical Rehabilitation Network (PRN). This position provides leadership, direction and ongoing administration and management for all aspects of PRN’s payer strategy and contracting. This position reports to the CEO and/or the executive team as needed.
Key Responsibilities:
- Negotiate and implement contracts with insurance companies and other third-party payers
- Prepare and analyze financial reports in support of contracting initiatives
- Develop and evaluate payment rates and strategies for contracting
- Analyze, develop and revise models to support contract negotiations, maximization of managed care reimbursement and minimization of operational costs
- Build and maintain professional and productive relationships with managers/directors of key contracted payer entities to maintain operational effectiveness
- Implement processes to simplify and improve contract administration
- Provide supporting role in monitoring, evaluating payment terms, administrative burdens and payment terms of payers
- Manage relationship between payers and revenue cycle department by assisting in monitoring AR from key payers and intervene when appropriate to resolve issues with various payers
- Conduct and coordinate routinely scheduled meetings with high profile and/or high- volume payers to discuss and identify problems/issues and work toward resolution with each payer
- Interpret payer contract language and understand contract details and the major provisions of agreements as they relate to day to day operations (e.g., timely filing limits, retro-activity, refunds, rate schedules, term notices, credentialing requirements, etc.)
- Assure compliance with regulatory requirements in relation to provider contracting functions
Education & Experience:
- Bachelor’s degree in health care administration, business or related field required
- Extensive experience working in a multiple locations/states healthcare environment
- 3+ year experiences in health care contracting role handling contract negotiations with accountability for business results
- Strong managerial competencies in the areas of finance and analytics
- High ethics and a high level of personal and professional integrity
Knowledge, Skills & Abilities:
- Strong working knowledge of payers, effective network strategies, managed care contracting ad negotiation, industry reimbursement trends, payer coverage policies and procedures, utilization review and payer quality
- Thorough knowledge of Medicare, Medicaid, Commercial and 3rd Party Payer billing practices
- Solid managerial acumen in setting corporate directions and aligning strategic goals around business plans
- Excellent relationship building skills and aptitude for working collaboratively with cross-functional groups
- Robust background in financial management and knowledgeable of federal and state laws and requirements relating to healthcare management
- Skilled at managing multiple projects and grasping new concepts
- Knowledge of healthcare industry and medical terminology
- Outstanding organizational skills
- Excellent internal and external customer service skills
- Effective communicator at all levels in the organization, with strong oral, written and persuasive skills
- Advanced proficiency in Microsoft Office Suite, especially with Excel
Travel Requirements:
Agency Referrals:
- This position is not accepting third-party recruiter or agency inquiries, principal only
This job description is not intended to be all-inclusive. Employee may perform other related duties as assigned to meet the ongoing needs of the organization.
We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, disability status, protected veteran status or any other characteristic protected by law.