Payer Contract Specialist

FUNCTIONS AND RESPONSIBILITIES

• Develop, negotiate, and maintain contracts with all payers, e.g., insurance companies, MSOs, IPAs, TPAs, and government programs. This includes researching territories to identify gaps with our payer base and supporting the expansion into new markets.
• Assure contractual arrangements meet financial targets and legal/regulatory compliance requirements. There will be an emphasis on analyzing cost and utilization data.
• Facilitate the approval process of all contract documents from pre-contract through post-signature phases.
• Responsible for the accuracy of supporting documentation for contracts and completing documents accurately.
• Maintain existing relationships with contracted providers. Ensure contractual language is kept current; evaluate fee schedule on a yearly basis to identify possible opportunities for additional covered services, medical policy changes and reimbursement.
• Complete Medicare enrollment for new entities and markets. Coordinate with internal teams as necessary to support Medicare assignments.
• Track and report contract renewal dates and alert management 90 days prior to renewal dates.
• Track contract status and ensure contracts transition to the next stage in the life cycle timely.
• Monitor for rate renewal, increases, and changes to ensure we realize the intended negotiated contracted rate.
• Meets routinely with system and health plans to resolve contracting/claims issues.
• Serve as a point of contact on health plan architecture, network restrictions, product offerings and other components of the health plan marketplace.
• Maintain excellent written and verbal communication with all internal and external customers.
• Assist with all contracting administration and projects, as needed.