Payer Relations & Contracts Specialist

capefearvalley; United States; On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

Health benefits

Job summary

Cape Fear Valley Health System in Fayetteville, North Carolina, seeks a skilled professional for the Managed Care Planning role within a clerical function. The position focuses on developing, implementing, and maintaining contractual relationships and related projects.

You will lead and assist in negotiating contracts, analyze reimbursement methodologies, and coordinate contract changes with internal teams and external stakeholders to ensure timely, accurate payments.

Qualifications

• Proficiency in reading, writing, and speaking English.
• Proficiency with standard office equipment and PC-based tools.
• Excellent written and verbal communication; able to interact with hospital management and external partners.

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

Verbal communication

Written communication

Computer literacy

Team player

Leadership

Education

High school diploma or equivalent

Bachelor's degree preferred or 8 years experience

Job description

Cape Fear Valley Health System in Fayetteville, North Carolina, seeks a skilled professional for the Managed Care Planning role within a clerical function. The position focuses on developing, implementing, and maintaining contractual relationships and related projects.

You will lead and assist in negotiating contracts, analyze reimbursement methodologies, and coordinate contract changes with internal teams and external stakeholders to ensure timely, accurate payments.