Payer Relations & Contracting Specialist
Job Summary
The Healthcare Payer Relations & Contracting Specialist holds a pivotal role in fostering positive relationships with healthcare payers and managing effective contracts to ensure fair and timely reimbursement for our hospice company's compassionate end-of-life care services.
Responsibilities
Draft, review, and negotiate contracts with healthcare payers, hospice service providers, and other partners.
Ensure that contracts align with the organization's strategic goals and comply with all legal and regulatory requirements.
Conduct detailed reviews of contract terms, payment rates, and performance metrics to identify areas for negotiation and improvement.
Collaborate with the Payer Relations & Contracting Manager and legal counsel to address contract-related issues.
Assist in maintaining positive relationships with healthcare payers and partners.
Work with the Payer Relations team to advocate for favorable reimbursement rates and terms.
Ensure that all contracts and agreements are accurately documented and stored in accordance with company policies.
Monitor compliance with contractual obligations, regulations, and accreditation standards.
Cross-Functional Collaboration:
- Collaborate with various departments, including Payer Relations, Revenue Cycle, Finance, Operations, and Legal, to support the organization's financial and operational goals.
Performance Metrics:
- Track and report on contract performance, including revenue and reimbursement data.
- Provide regular updates to management on the status of contracts and payer relationships.
Payer Relationship Management:
- Cultivate and maintain strong working relationships with healthcare payers, including insurance companies, government programs (Medicare and Medicaid), hospice associations, and other third-party payers.
- Serve as the primary point of contact for both internal and external partners at the health plans, state, and hospice associations.
Communication and Collaboration:
- Facilitate regular communication with payers to address inquiries, resolve issues, and negotiate favorable terms.
- Collaborate with internal departments, including Contracting, Credentialing, Revenue Cycle, Operations, Finance and Quality Assurance, to support effective payer relations.
- Assist PR&C Manager collaborations with state and hospice association.
Contract Advocacy:
- Work with the Contract Specialist to advocate for favorable contract terms and reimbursement rates during contract negotiation processes.
- Monitor the impact of contract terms on reimbursement and report findings to the Payer Relations & Contracting Manager.
Claims and Reimbursement:
- Monitor and track the status of claims escalations, ensuring timely and accurate reimbursement from payers.
- Collaborate with the PR&C Manager and Revenue Cycle team to address payment discrepancies or denials and identify trends.
- Assist the PR&C Manager with the preparation of reports on payer performance and trends for internal stakeholders.
Continuous Improvement:
- Proactively identify opportunities to enhance the department's efficiency and effectiveness to report back to the PR&C Manager.
- Recommend and implement process improvements to enhance contract management and negotiation processes.
Requirements
Minimum of 3 years of experience in contract management, preferably in a healthcare or hospice setting.
Strong understanding of healthcare payer systems, reimbursement models, and insurance policies.
Excellent negotiation and communication skills.
Exceptional relationship-building skills.
Detail-oriented with strong analytical abilities.
Ability to analyze data and make data-driven decisions.
Knowledge of healthcare regulations and compliance standards.
Proficiency in contract management software and Microsoft Office Suite.
Ability to work both independently and as part of a team.
Strong problem-solving skills and the ability to adapt to changing industry dynamics.
Bachelor's degree in business, healthcare administration, or a related field preferred.