Payor Specialist - Contract Management Support - Southwestern Health Resources

Southwestern Health Resources; Dallas (TX); Hybride; USD 80 000 - 110 000; Plein temps

Avantages offerts par ce poste

Hybrid position

Mentorship

Training programs

Leadership resources

Résumé du poste

Southwestern Health Resources is seeking a skilled Payor Analyst to review and interpret payor contracts, track key terms, and prepare amendments. The role supports contract operations, project management, and cross-functional initiatives within a hybrid work model with limited onsite days.

You will collaborate with providers, payors, and internal teams to resolve issues, monitor timelines, and communicate financial impacts.

Qualifications

• Bachelor's Degree in Business or Healthcare, 4 years required, or Master's degree preferred.
• 4+ years of experience in managed care, payor relations, or healthcare operations.
• Familiarity with healthcare payor systems and contract language.
• Excellent project management and problem-solving skills.
• Strong analytical and communication skills.

Responsabilités

• Review and interpret payor contracts to understand contract language, financial incentives, and other relevant items of the contract.
• Assist with maintaining contract language key terms by payor tracking grid.
• Prepare routing documents for new contracts and amendments.
• Review and redline low-level amendments (e.g., term extensions, quality measure updates) and exhibits.
• Complete and distribute new contract orientation forms and communications to internal stakeholders.
• Maintain organized records of contract status, amendments, and stakeholder communications.
• Maintain project tracker by payor and monitor project status.
• Participate in payor calls, identify trends, and document outcomes.
• Escalate unresolved issues to appropriate parties and follow through to resolution.
• Maintain and update project trackers, ensuring alignment with stakeholders and timelines.
• Interpret and communicate contract changes to internal stakeholders.
• Collaborate with analysts to assess financial implications of new contracts or amendments.
• Notify payors of significant impacts within required timeframes and monitor resolution status.
• Document and communicate new contracts and changes to relevant teams.
• Support cross-functional managed care initiatives and respond to provider or payor queries.
• Communicate with providers, payors, and internal stakeholders to resolve issues and improve processes.
• Collect, organize, and present data in a clear format.
• Provide timely updates and final reports to requesting departments or leadership.
• Ensure all project documentation is complete, accurate, and accessible.
• Represent the Market and Payor Relations team in committees and workgroups.

Connaissances

Payor systems

Contract language

Project management

Analytical skills

Communication skills

Formation

Bachelor's degree in Business/Healthcare

Master's degree preferred

Description du poste

Southwestern Health Resources is looking for a highly skilledPayor Analyst. Is that you?

Work Hours:Full Time Days (8:00am-5:00pm) for 40 hrs/week (remote work allowed at manager's discretion)

Onsite Requirement: 2 Days a week

Department Highlights:

• Hybrid Position
• Gain a sense of accomplishment by contributing to a teamwork environment.
• Receive excellent mentorship, comprehensive training, and dedicated leadership resources.
• Contribute and work on a cross functional team

What You Will Do:

Contract Management Support:
. Review and interpret payor contracts to understand contract language, financial incentives, and other relevant items of the contract.
. Assist with maintaining contract language key terms by payor tracking grid.
. Prepare routing documents for new contracts and amendments.
. Review and redline low-level amendments (e.g., term extensions, quality measure updates) and exhibits
. Complete and distribute new contract orientation forms and communications to internal stakeholders.
. Maintain organized records of contract status, amendments, and stakeholder communications.
30%
Project Management:
. Maintain project tracker by payor (e.g., Aetna, BCBSTX, Cigna, UHC) and monitor project status.
. Participate in payor calls, identify trends, work with payors to resolve issues and document outcomes.
. Escalate unresolved issues to appropriate parties and follow through to resolution.
. Maintain and update project trackers, ensuring alignment with internal stakeholders and timelines.
30%
Contract Operations - New Contracts and Amendments
. Interpret and communicate contract or contract changes to internal stakeholders.
. Collaborate with analysts to assess the financial implications of a new contract or contract amendments for internal stakeholders.
. Notify payors of significant impacts within required timeframes and monitor resolution status.
. Document and communicate new contract and contract changes and outcomes to relevant internal teams.
10%
Managed Care Projects & Provider/Payor Queries
. Support cross-functional managed care initiatives and respond to provider or payor-related queries.
. Communicate with providers, payors, internal stakeholders (quality, medical economics, finance), and others to resolve issues and improve processes.
. Collect, organize, and present data in a clear and actionable format.
. Provide timely updates and final reports to requesting departments or leadership.
. Ensure all project documentation is complete, accurate, and accessible.
20%
Committee Participation
. Represent the Market and Payor Relations team in internal and external meetings, committees, and workgroups.
. Actively participate in discussions, share insights, and contribute to strategic planning efforts.
. Build and maintain strong relationships with providers, payors and internal departments to support collaborative problem-solving. 10%

What You Need:

Education
Bachelor's Degree Business or Healthcare 4 Years Req Or
Master's Degree Business or Healthcare Pref
Experience
4 Years 4 Years of Experience in managed care, payor relations, or healthcare operations Req
Skills
Familiarity with healthcare payor systems and contract language.
Experience with policy impact analysis and claims resolution.
Ability to work independently and collaboratively in a fast-paced environment.
Excellent project management and problem-solving skills.
Detail-oriented.
Strong analytical skills.
Excellent oral and written communication skills.
Supervision
Individual Contributor
Budget Responsibility
Primary Budget Responsibility Less than $100 Thousand $80k - 110K
ADA Requirements
Working Indoors 67% or more
Physical Demands
Sedentary

Additional Information

• Job Field: Clerical/Admin
• Shift: Day Job
• Schedule: Full-time