Payor Relations Specialist - CHOPPA

About the role

The Payor Relations Specialist assists the Reimbursement Strategy and Contracting Department to understand the CHOP payor contracts to ensure contract compliance, improve revenue streams, mitigate administrative barriers, and other managed care-related issues across the health system. The Payor Relations Specialist coordinates with the departmental and divisional leadership to understand all unresolved managed care issues and escalate them with the payor after the individual CHOP entity has exhausted its leverage with the payor.

Responsibilities

• Supports the enterprise by being the source of information related to payor contracts, payor policies and guidelines, new plan information (market intel) and other relevant information related to the payor market.
• Provides monthly updates of payor policies and procedures within the health system.
• Interacts with all individuals in the organization in a professional and customer-focused manner.
• Provides contract interpretation support and education for the health system.
• Possesses strong understanding of the local managed care environment, including, but not limited to, managed care policies and procedures, payment models and managed care models.
• Must possess strong understanding of the local managed care environment, including, but not limited to, managed care policies and procedures, payment models and managed care models.
• Must be organized and detail-oriented.
• Must be able to work independently, achieve specific goals and objectives, and provide recommendations for improvement.
• Must be able to work collaboratively with a strong orientation for bottom line results.
• Must possess excellent communication skills, demonstrated organizational skills, ability to multi-task.
• Must be able to work with large sets of diverse data with the ability to summarize into meaningful, presentable, and actionable information.
• Must be able to interpret complex and comprehensive managed care information.
• Works closely with Access and Revenue Cycle teams to identify and remove or reduce access and revenue cycle barriers.

Requirements

• At least seven (7) years industry and topical related experience.
• Bachelor's Degree.
• Strong understanding of the local managed care environment, including, but not limited to, managed care policies and procedures, payment models and managed care models.
• Excellent communication skills, demonstrated organizational skills, ability to multi-task.
• Strong interpersonal skills.
• Organized and detail-oriented.
• Able to work independently, achieve specific goals and objectives, and provide recommendations for improvement.
• Able to work collaboratively with a strong orientation for bottom line results.
• Able to work with large sets of diverse data with the ability to summarize into meaningful, presentable, and actionable information.
• Able to interpret complex and comprehensive managed care information.

Skills And Abilities

• Strong understanding of the local managed care environment, including, but not limited to, managed care policies and procedures, payment models and managed care models.
• Excellent communication skills, demonstrated organizational skills, ability to multi-task.
• Strong interpersonal skills.
• Organized and detail-oriented.
• Able to work independently, achieve specific goals and objectives, and provide recommendations for improvement.
• Able to work collaboratively with a strong orientation for bottom line results.
• Able to work with large sets of diverse data with the ability to summarize into meaningful, presentable, and actionable information.
• Able to interpret complex and comprehensive managed care information.

Benefits

CHOP does not discriminate on the basis of race, color, sex, national origin, religion, or any other legally protected categories in any employment, training, or vendor decisions or programs. CHOP recognizes the critical importance of a workforce rich in varied backgrounds and experiences and engages in ongoing efforts to achieve that through equally varied and non-discriminatory means.

Pay

SALARY RANGE: $74,250.00 - $94,660.00 Annually

Schedule

Shift: Day