Payer Contract Specialist

About the role

The Payer Contract Specialist plays a critical role in the management and oversight of payer contracts, serving as the “go-to” representative for insurance partners and internal teams. This role involves managing day-to-day responsibilities related to managed care contracting and payer/provider relations, including acting as a liaison between provider and contracted health plans.

Responsibilities

• Coordinate administrative tasks with internal departments to address questions, issues, and activities related to provider contracts
• Maintain records for correspondence and documentation in relation to established contracts and those in progress
• Maintain a complete and accurate record of all executed agreements and associated rate schedules
• Solve any contract-related problems that may arise with other parties and internally within the department and investigate/identify solutions for contractual issues
• Streamline communication and assist in automating processes
• Identify recurring documentation or process issues and recommend improvements to templates or information requirements
• Partner with internal stakeholders to address escalations related to provider payment, network participation, and directory accuracy
• Participate in complex projects related to provider contracts, reimbursement methods, documentation and amendments, and participate in internal workgroups and committees, ensuring compliance
• Prepare, review, and process routine LOA agreements, approval requests, and other related documentation using approved templates
• Work closely with the Payer Contract Administrator and serve as a backup when needed

Requirements

• Effective time and project management skills to plan and monitor activities to ensure achievement of departmental goals
• Strong interpersonal skills to effectively interface with all levels of staff, providers, vendors, and business-related associates
• Strong analytical, problem-solving and critical thinking skills, with the ability to use reason to identify problems, gather data, establish facts, draw valid conclusions and develop suitable recommendations
• Strong relationship building skills, along with an understanding of contractual documents and the ability to effectively communicate terms
• Organizational skills and ability to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence
• Comprehension of managed care principles and practices, with substantial knowledge of business concepts and terminology specific to the health care industry and managed care contract terms and reimbursement methodologies
• Strong knowledge and understanding of Revenue Cycle processes (i.e. referrals, authorizations, denials, benefit designs, billing/claims, audits, coding, and reimbursement)

Qualifications

• Education: Must have working-level knowledge of the English language, including reading, writing, and speaking English. Bachelor’s degree in business healthcare related field, business or financial degree preferred.
• Experience: Three to Five (3-5) years of healthcare experience in a managed care environment. Prior experience may include anything within the Revenue Cycle, Contracting, Health Insurance and/or Provider Relations.
• Computer / Typing: Must be proficient with Microsoft Office Suite, including Outlook, PowerPoint, Excel, and Word and have the ability to use the computer to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc.