Payor Development Specialist

Northside Hospital Inc.; Atlanta (GA); On-site; USD 70,000 - 90,000; Full time

Job summary

Northside Hospital is seeking a Payor Development Specialist to operationalize COE contractual arrangements and support the payor development team within Managed Care. You will work closely with Contract Managers to manage COE negotiations, education, and process implementation.

You will help maintain payer relationships, review contracts, and resolve claim issues while supporting education for physician practices and COE mappings. Strong communication and analytical skills are essential.

Qualifications

• Bachelor's Degree or equivalent experience in healthcare or provider relations
• Strong understanding of reimbursement methodologies
• Strong understanding of claims adjustment processes and related activities
• Ability to work independently and communicate effectively

Responsibilities

• Maintain positive relationships with assigned COE payers and participate in COE negotiations
• Serve as liaison between billing staff, practices, and COE health plans to resolve claim issues
• Support contract management, fee schedule maintenance, and contract education for physicians
• Assist in COE application processes, provider mapping, and plan code mapping
• Act as primary contact/resource for assigned payers and ensure contract updates are implemented

Skills

Analytical skills

Communication skills

Organizational skills

Independent worker

Education

Bachelor's degree or equivalent experience

Tools

Microsoft Excel

Microsoft Access

McKesson Trendstar CPA

Job description

Overview

Northside Hospital is award-winning, state-of-the-art, and continually growing. Constantly expanding the quality and reach of our care to our patients and communities creates even more opportunity for the best healthcare professionals in Atlanta and beyond. Discover all the possibilities of a career at Northside today.

Responsibilities

Responsible for operationalizing Centers of Excellence (COE) contractual arrangements. Supports the payor development team within Managed Care and the broader Northside enterprise. Is familiar with a wide variety of COE bundled surgical arrangements and Payor Relations concepts, practices and procedures necessary to meet the goals of the Northside enterprise. The Payor Development Specialist will work closely with each Contract Manager and will support various aspects of COE bundled arrangement negotiations, practice education and process implementation. The Payor Development Specialist will be particularly focused on overall relationship management, contract and fee schedule maintenance, issue resolution, process implementation, physician practice education and contract identifiers and coding.

The Payor Development Specialist serves as a back-up to the Contract Manager in support of assigned Payor Relationships, both internally and externally.

++PRIMARY DUTIES AND RESPONSIBILITIES++

• Maintain positive relationships with all assigned Centers of Excellence (COE) payers
• Participates in and supports negotiations for COE arrangements
• Serves as the point of contact between Northside's professional billing staff, provider practices and COE health plans to assist with the resolution of claim and process issues
• Assists in the management of trended claim and process issues with the Program Coordinator and Contract Manager
• Provide education to physician practices regarding correct procedures for managing cases
• Ensure the quarterly updates for contracts are implemented accurately
• Review patient cases to ensure accurate provider assignment is made per the contract
• Resolve claim issues for all assigned payers by maintaining relationships with providers, PBS and hospital billing contacts
• Works with Contract Manager to support the COE application process, practice contacts and provider procedure and location mapping, and plan code mapping
• Serve as the primacy contact/resource for all assigned payers

Qualifications

• REQUIRED:
• Bachelor's Degree or equivalent experience of no less than four years healthcare or provider relations/provider contracting experience
• Strong understanding of reimbursement methodologies
• Strong understanding of activities, practices, tools and considerations for managing the claims adjustment process.
• Ability to work independently
• Strong analytical skills
• Excellent organizational skills
• Excellent communication skills
• Strong working knowledge of computer spreadsheet programs and database programs such as Access
• PREFERRED:
• McKesson/HBOC Trendstar CPA
• Microsoft Excel and Access

Work Hours:

8AM-5PM

Weekend Requirements:

No

On-Call Requirements:

No