Job Description

SUMMARY OF RESPONSIBILITY: Under the general direction of the Manager, Payer Contract Administration, identifies issues of concern or importance to SoNE Heatlh, SoNE providers and THOfNE (SoNE) and advocates for SoNE's interests with the payors. Serves a payer liaison with SoNE practices by establishing multiple communication channels with practices and facilities. Serves as key contact for contract implementation, policy changes by the payors, communicates with appropriate SoNE management, and advocates on behalf of SoNE with payers. Strengthens and maintains relationships with key payors, promotes SoNE's interests and educates payors about SoNE. Facilitates effective working relationships between key individuals at major payors and appropriate management staff at SoNE. Represents SoNE at payor and THOfNE revenue cycle meetings and advocates on behalf of SoNE with payors. Coordinates internal efforts to identify and address issues and facilitate communication regarding payor issues among SoNE operational managers.

This role is located at the company's headquarters in Windsor, CT and operates in a semi-virtual environment.

ESSENTIAL FUNCTIONS:

• Identify operational issues with key payors and negotiate successful resolutions.
• Serve as key liaison to major payors and maintain close working relationship with key payor operational staff and negotiate resolutions for issues related to payments/denials, policy updates, substantial changes in benefits, enrollment or operational issues.
• Serves a primary contact for SoNE providers for all operational and contract related matters, including rate inquiries. Revenue cycle matters for SoNE providers and THOfNE issues are priority. Provides the highest level of customer service by responding to inquiries within 24 hrs. Assigns backup when not available.
• Serves as liaison for provider credentialing for non-delegated, non-APM contracts by distributing monthly provider rosters, confirming receipt and successful intake of monthly rosters.
• Maintains Payor Contracting Grid with assistance from contracting staff to ensure grid is up to date each month.
• Maintains provider access to Fee Schedule Look Up Tool. Oversees routine adds and deletes.
• Establish communication channels with SoNE and SoNE providers’ practice management to assure bidirectional flow of information regarding payor issues relevant to their work and facilitate communication between SoNE and SoNE providers’ operational managers and appropriate staff at payors to optimize operations.
• Conducts practice education programs as needed with guidance from contracting staff.
• Establish and maintain contracting department deliverables schedule/calendar.
• Manage payor initiatives such as tiering methods, product updates, policy and procedure changes, payor training.
• Coordinates on behalf of Contracting department, internal projects related to payors and contracts.
• Negotiates special contracts as needed.

Other Functions:

• Performs other duties as assigned.

The duties listed above are intended only as illustrative of the various types of work that may be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar or a logical assignment to the position.

QUALIFICATIONS AND COMPETENCIES:

• Minimum 5 years healthcare payor or provider customer service experience
• Demonstrated successful problem resolution and effective project management skills
• Experience with complex provider organization preferred
• Excellent customer service skills
• Excellent communication skills including written and verbal communication
• Ability to work with individuals at multiple levels of organizations to identify problems and bring them to satisfactory resolution
• Ability to anticipate impact of proposed payer policy and procedure changes and to communicate them to key stakeholders
• Ability to consistently maintain appropriate professional demeanor under sometimes stressful circumstances
• Ability to analyze mathematical data
• Bachelor’s degree required

P HYSICAL AND MENTAL REQUIREMENTS:

The Physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of the job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Ability to work long hours – over eight in a work day, and over 40 in a work week as necessary;

• Regularly required to use hands to finger, handle or feel objects, tools, or controls; reach with hands and arms; and talk or hear
• Frequently is required to walk and sit
• Occasionally required to stand; climb or balance; and stoop, kneel, crouch or craw.
• Ability to lift and/or move up to 20 pounds
• Vision abilities required by this job include close vision, color vision, peripheral vision, depth perception and ability to adjust focus
• The dexterity necessary to utilize a computer keyboard on a regular basis is essential

ADDITIONAL REQUIREMENTS:

As a condition of employment at SoNE HEALTH and for the safety and well-being of our employees:

• All employees must reside in New Hampshire, Rhode Island, Maine, Vermont, Connecticut, or Massachusetts.
• All employees are required to be fully vaccinated for influenza and COVID-19.

Salary Range: $56,075- $72,897