Payer Relations & Contracts Lead

Cape Fear Valley Health System; United States; On-site; USD 70,000 - 100,000; Full time

Job summary

Cape Fear Valley Health System seeks a contracts professional to assist and sometimes lead the negotiation and maintenance of managed care contracts. You will coordinate reimbursement analyses and ensure timely contract updates across stakeholders.

Ideal candidates have 3+ years in medical business or managed health care and strong written and verbal communication. This role supports loading contract changes, policy monitoring, and escalation of claims with Payers.

Qualifications

• High school diploma or equivalent required.
• Bachelor’s degree preferred or 8 years of related experience.
• 3 years medical business experience in a related field or managed health care experience preferred.
• Experience working directly with employers, insurance companies and/or physicians is strongly preferred.

Responsibilities

• Assist and, in some cases, lead negotiating and maintaining managed care contracts
• Coordinate reporting that analyze reimbursement methodologies and rates to determine payment accuracy
• Assist in developing, implementing and maintaining a system of renewal and reporting to monitor the status, performance and viability of contracts
• Work with internal and external stakeholders to ensure appropriate and timely loading of contract changes
• Monitor Managed Care websites for any change in policy
• Work with PFS to determine appropriate claims for escalation
• Work with Payers on appeals of denial
• Maintain, monitor and report on managed care recoupment activities
• Work with Client billing lists to ensure contracts are being reimbursed
• Maintain and validate third-party commercial refund requests
• Other duties as assigned

Skills

Interpersonal skills

Analytical skills

Financial skills

Leadership

Written and verbal communication

Education

Bachelor’s degree preferred

8 years of experience preferred

Job description

Cape Fear Valley Health System seeks a contracts professional to assist and sometimes lead the negotiation and maintenance of managed care contracts. You will coordinate reimbursement analyses and ensure timely contract updates across stakeholders.

Ideal candidates have 3+ years in medical business or managed health care and strong written and verbal communication. This role supports loading contract changes, policy monitoring, and escalation of claims with Payers.