Payor Relations Specialist - CHOPPA

Children's Hospital of Philadelphia; Philadelphia (Philadelphia County); On-site; USD 76,000 - 97,000; Full time

Job summary

CHOP is seeking a Payor Relations Specialist to support the Reimbursement Strategy and Contracting Department in understanding payor contracts, ensuring contract compliance, improving revenue streams, and reducing administrative barriers across the health system.

You will coordinate with department and divisional leadership to address unresolved managed care issues, participate in analyzing new and renewal contracts with payors, and assist in contract negotiations as needed.

Qualifications

• Bachelor's Degree required.
• 7+ years industry experience in payor contracts or managed care.
• Strong analytical and communication abilities.

Responsibilities

• Supports the enterprise by being the source of information related to payor contracts and policies.
• Provides contract interpretation and education; identifies opportunities in payor agreements.
• Organizes and leads contract implementation, including new agreements and terminations.
• Serves as primary contact with payors for rate changes and collaborates with Revenue Analytics.

Skills

Managed care knowledge

Communication skills

Organizational skills

Interpersonal skills

Independent work

Written and oral communication

Data interpretation

Collaboration

Education

Bachelor's Degree - Required

Tools

EPIC

Microsoft Office

Job description

Seeking Breakthrough Makers

Children’s Hospital of Philadelphia (CHOP) offers countless ways to change lives. Our diverse community of more than 20,000 Breakthrough Makers will inspire you to pursue passions, develop expertise, and drive innovation.

SHIFT:

Day (United States of America)

Seeking Breakthrough Makers

Children’s Hospital of Philadelphia (CHOP) offers countless ways to change lives. Our diverse community of more than 20,000 Breakthrough Makers will inspire you to pursue passions, develop expertise, and drive innovation.

At CHOP, your experience is valued; your voice is heard; and your contributions make a difference for patients and families. Join us as we build on our promise to advance pediatric care—and your career.

CHOP does not discriminate on the basis of race, color, sex, national origin, religion, or any other legally protected categories in any employment, training, or vendor decisions or programs. CHOP recognizes the critical importance of a workforce rich in varied backgrounds and experiences and engages in ongoing efforts to achieve that through equally varied and non-discriminatory means.

A Brief Overview

The Payor Relations Specialist assists the Reimbursement Strategy and Contracting Department to understand the CHOP payor contracts to ensure contract compliance, improve revenue streams, mitigate administrative barriers, and other managed care-related issues across the health system. The Payor Relations Specialist coordinates with the departmental and divisional leadership to understand all unresolved managed care issues and elevate them with the payor after the individual CHOP entity has exhausted its leverage with the payor.

What You Will Do

• The Payor Relations Specialist supports the enterprise by being the source of information related to payor contracts, payor policies and guidelines, new plan information (market intel) and other relevant information related to the payor market. Provides monthly updates of payor policies and procedures within the health system. Interacts with all individuals in the organization in a professional and customer-focused manner.
• Provides contract interpretation support and education for the health system. Prospectively identifies operational and financial opportunities for the health system specific to a new payor agreement. Organizes and leads contract implementation process with completion of new agreements and contract terminations.
• In partnership with the Reimbursement Strategy and Contracting leaders, is an active participant in analyzing new and renewal contracts with the payors. Tracks and prepares business perspectives of contracts for Legal review. Supports other contract negotiations as required.
• Serves as the primary point of contact with payors for contractual rate changes for the PFS-P to the Manager of Revenue Analytics. Works closely with Access and Revenue Cycle teams to identify and remove or reduce access and revenue cycle barriers.

Education Qualifications

• Bachelor's Degree - Required

Experience Qualifications

• At least seven (7) years industry and topical related experience - Required

Skills And Abilities

• Must possess strong understanding of the local managed care environment, including, but not limited to, managed care policies and procedures, payment models and managed care models.
• Excellent communication skills, demonstrated organizational skills, ability to multi-task.
• Strong interpersonal skills. Must be organized and detail-oriented.
• Ability to work independently, achieves specific goals and objectives, and provides recommendations for improvement.
• Ability to work collaboratively with a strong orientation for bottom line results.
• Excellent written and oral (presentation) skills.
• Strong working knowledge of key computer applications such as EPIC and Microsoft Office suite of products.
• Ability to work with large set of diverse data with the ability to summarize in to meaningful presentable and actionable information
• Ability to interpret complex and comprehensive managed care information.

To carry out its mission, CHOP is committed to supporting the health of our patients, families, and global community. As a condition of employment, CHOP employees who work in patient care buildings or who have patient facing responsibilities must receive an annual influenza vaccine. Learn more.

EEO / VEVRAA Federal Contractor | Tobacco Statement

SALARY RANGE

$76,100.00 - $97,000.00 Annually

Salary ranges are shown for full-time jobs. If you're working part-time, your pay will be adjusted accordingly.

At CHOP, we are committed to fair and transparent pay practices. Factors such as skills and experience could result in an offer above the salary range noted in this job posting. Click here for more information regarding CHOP's Compensation and Benefits.