Payer Relations Coordinator-Full Time-Days

Cape Fear Valley Health; Fayetteville, Northern (NC, KY); On-site; USD 65,000 - 90,000; Full time

Job summary

Cape Fear Valley Health is seeking a Contract Specialist to assist in developing and maintaining contractual relationships and to lead select projects. The role requires collaboration with employers, insurers, and physicians to ensure accurate reimbursement and timely contract changes.

Responsibilities include negotiation, reporting on reimbursement methodologies, and monitoring policy changes. A strong analytical mindset, clear communication, and leadership are essential for success in this

Qualifications

• High school diploma or equivalent required.
• Bachelor’s degree preferred OR 8 years of experience preferred.
• 3 years medical business experience in a related field or managed health care experience preferred.

Responsibilities

• Assist and, in some cases, lead negotiating and maintaining managed care contracts.
• Coordinate reporting that analyzes reimbursement methodologies and rates to determine payment accuracy.
• Assist in developing, implementing and maintaining a system of renewal and reporting to monitor contract status and viability.
• Work with internal and external stakeholders to ensure loading of contract changes.
• Monitor Managed Care websites for any policy changes.
• Work with PFS to determine appropriate claims for escalation and with Payers on appeals of denial.

Skills

Analytical skills

Financial analysis

Interpersonal communication

Leadership

Education

Bachelor’s degree preferred OR 8 years of experience

Job description

Summary

Assist in developing, implementing and maintaining contractual relationships as well as take lead on other projects.

Major Job Functions

• 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

Minimum Qualifications

Education and Formal Training:

• High school diploma or equivalent required
• Bachelor’s degree preferred OR 8 years of experience preferred

Work 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

Knowledge, Skills, and Abilities Required:

• Proficiency in reading, writing, and speaking the English language
• Proficiency with personal computer, electronic calculator, fax machine and copy machine
• Excellent interpersonal skills with the ability to interact with hospital management, physicians and outside organizations
• Ability to be effective with little to no day-to-day supervision
• Possess and demonstrate strong written and verbal skills, be results oriented, and exemplify a team player attitude
• Strong analytical and financial skills to determine the potential economic impact of relationships, contracts and contract alternatives
• Ability to demonstrate effective leadership traits and competently execute decisions
• Ability and willingness to work on a variety of activities and projects
• Ability to work with people in a tactful, diplomatic manner

Physical Requirements:

Present a professional and executive image to effectively present proposals and favorably influence clients.

Position requires a flexible schedule.

Required Licenses and Certifications:

None specified.

Cape Fear Valley Health System is an Equal Opportunity Employer M/F/Disability/Veteran/Sexual Orientation/Gender Identity.

About Cape Fear Valley Health

For exceptional healthcare come to Cape Fear Valley Health where caring employees are committed to integrity, patient-centeredness and excellence throughout the entire healthcare process. At Cape Fear Valley Health, our goal is to improve the quality of every life we touch. Our diverse team of doctors, nurses and staff work together to create a better experience for every patient, every time. Cape Fear Valley is a 950-bed, 8-hospital regional health system, the 8th largest in North Carolina, with more than 1 million inpatient and outpatients annually. A private not-for-profit organization with over 7,000 employees and 850 physicians. Our employees and physicians proudly serve a seven-county region of southeastern North Carolina, including Fayetteville, Fort Bragg, Hope Mills, Raeford, Lumberton, Elizabethtown, Clinton, Lillington, Dunn and beyond. Our medical facilities include Cape Fear Valley Medical Center, Highsmith-Rainey Specialty Hospital, Cape Fear Valley Rehabilitation Center, Behavioral Health Care, Bladen County Hospital, Hoke Hospital, Central Harnett Hospital, Betsy Johnson Hospital, as well as more than 60 medical offices and specialty care clinics spread throughout the Cape Fear region.