Health Insurance Contracting & Payer Relations Admin I

Johns Hopkins Health System; Baltimore (MD); A distancia; USD 43.000 - 72.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Career growth

Diverse collaboration

Paid time off

Tuition reimbursement

Comprehensive benefits

Descripción de la vacante

Johns Hopkins Medicine is seeking a detail-oriented administrator to oversee Single Case Agreements (SCAs) and payer contract activities, ensuring compliance across contracted and non-contracted payors. You will serve as a resource to staff and leadership, guiding managed care operations and reimbursement strategies.

The role emphasizes collaboration with payer representatives and internal teams, delivering training and materials on SCA workflows while monitoring performance and regulatory

Formación

• Bachelor's Degree in business administration or healthcare administration, or a related field (Required)
• One year of relevant education may be substituted for one year of required work experience or one year of relevant professional-level work experience may be substituted for one year of required education.
• Experience in payer relations or contract management (Required)
• Navigate rapidly changing situations, from evolving patient needs to technological advancements, by remaining flexible, continuously learning, embracing new challenges, and quickly recovering from setbacks.
• Good written and verbal communication skills with an emphasis on confidentiality, tact, and diplomacy.
• Strong attention to detail and self-directed to consistently ensure data integrity and accuracy.

Responsabilidades

• Negotiates and manages Single Case Agreements (SCAs) and payer contract activities for contracted and non-contracted payors.
• Assists with the identification and coordination of non-contracted patient cases requiring SCA review and operational follow-up.
• Coordinates the implementation, execution, maintenance, and compliance of SCAs and payer contract documentation.
• Develops and maintains collaborative relationships with payer representatives and internal stakeholders.
• Provides operational guidance and serves as a resource regarding managed care, reimbursement, and SCA workflows.
• Develops and delivers education, training, and resource materials related to SCAs, payer operations, and managed care processes.
• Monitors payer contract and SCA performance, reimbursement activity, operational effectiveness, and regulatory developments.
• Supports process improvement and operational implementation initiatives related to payer relations and managed care activities.
• Prepares reports, analyses, and summaries related to SCA activity and payer relations.
• Acts as operational resource to departments regarding payer and reimbursement issues.

Conocimientos

Payer relations

Contract management

Communication skills

Data accuracy

Educación

Bachelor's Degree in business administration or healthcare administration

Descripción del empleo

What Awaits You?

• Career growth and development
• Diverse and collaborative working environment
• Generous Paid Time Off
• Tuition Reimbursement
• Affordable and comprehensive benefits package

This is a remote role- applicants working from MD, DC, VA, PA, DE or FL will be given first consideration.

Job Summary

Ensures compliance with the administration, negotiation, implementation, surveillance, and oversight of Single Case Agreements (SCAs) for contracted and non-contracted payors. Serves as a resource for staff at all JHM Operational Units, Senior Management levels as well as front line staff regarding SCA processes, managed care contracts, and payer reimbursement guidelines. Provides operational guidance and coordination related to SCA negotiations, payer relations, contract compliance, and reimbursement activities to support effective and complaint managed care operations. Provides oversight, surveillance, and maintenance of Managed Care SCA reference materials and SCA-related information posted on the Managed Care website to ensure accuracy, accessibility, and compliance with organizational and payer requirements.

Job Functions

• Negotiates and manages individual patient Single Case Agreements (SCAs) and payer contract activities for contracted and non-contracted payors.
• Assists with the identification and coordination of non-contracted patient cases requiring SCA review and operational follow-up.
• Coordinates the implementation, execution, maintenance, and compliance of SCAs and payer contract documentation.
• Develops and maintains collaborative relationships with payer representatives and internal stakeholders.
• Provides operational guidance and serves as a resource regarding managed care, reimbursement, and SCA workflows.
• Develops and delivers education, training, and resource materials related to SCAs, payer operations, and managed care processes.
• Monitors payer contract and SCA performance, reimbursement activity, operational effectiveness, and regulatory developments.
• Supports process improvement and operational implementation initiatives related to payer relations and managed care activities.
• Prepares reports, analyses, and summaries related to SCA activity and payer relations.
• Acts as operational resource to departments regarding payer and reimbursement issues.

Qualifications

• Bachelor's Degree in business administration or healthcare administration, or a related field (Required)
• One year of relevant education may be substituted for one year of required work experience or one year of relevant professional-level work experience may be substituted for one year of required education.
• Experience in payer relations or contract management (Required)
• Navigate rapidly changing situations, from evolving patient needs to technological advancements, by remaining flexible, continuously learning, embracing new challenges, and quickly recovering from setbacks.
• Good written and verbal communication skills with an emphasis on confidentiality, tact, and diplomacy.
• Strong attention to detail and self-directed to consistently ensure data integrity and accuracy.

Salary Range: Minimum 31.53/hour - Maximum 52.06/hour. Compensation will be commensurate with equity and experience for roles of similar scope and responsibility. In cases where the range is displayed as a $0 amount, salary discussions will occur during candidate screening calls, before any subsequent compensation discussion is held between the candidate and any hiring authority.

The Hospital reserves the right to modify employee schedules as needed.

We are committed to creating a welcoming and inclusive environment, where we embrace and celebrate our differences, where all employees feel valued, contribute to our mission of serving the community, and engage in equitable healthcare delivery and workforce practices.

Johns Hopkins Health System and its affiliates are drug-free workplace employers.