Payor Relations Specialist - CHOPPA

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

Job summary

The Payor Relations Specialist at The Children's Hospital of Philadelphia coordinates with the Reimbursement Strategy and Contracting Department to understand payor contracts, ensure compliance, and improve revenue cycles across the health system.

Key duties include contract interpretation, identifying operational opportunities, and leading contract implementations and renewals. Strong experience in managed care and excellent communication are required.

Qualifications

• Bachelor's degree required.
• At least seven years of related experience.
• Strong understanding of local managed care environment.
• Excellent communication and organizational skills.

Responsibilities

• Maintains knowledge of payor contracts, policies and guidelines across the health system.
• Provides contract interpretation and education to the health system; identifies opportunities for payor agreements.
• Analyzes new and renewal contracts with payors; prepares business perspectives for Legal review.
• Acts as primary contact with payors for rate changes and collaborates with Access and Revenue Cycle teams to remove barriers.

Skills

Communication

Organization

Multitasking

Interpersonal skills

Independent work

Team collaboration

Presentation

EPIC

Microsoft Office

Data summarization

Managed care knowledge

Education

Bachelor's Degree

Tools

EPIC

Microsoft Office

Job description

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, workforce, 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.

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.