Payor Strategy Contract Coordinator

TridentCare; United States; Remote; USD 55,000 - 85,000; Full time

Job summary

TridentCare in the United States is seeking a Contract Coordinator to manage the contractual process for managed care proposals, load and test fee schedules, and ensure compliance with federal, state, and local guidelines.

You will partner with the Sr. Manager RCM and Billing teams, analyze profitability of contracts, and communicate terms across departments to support accurate reimbursements and timely payor decisions.

Qualifications

• 3 years contracting experience
• 4 years minimum experience in health care billing/accounting
• High School Diploma required
• Experience with contract management software preferred

Responsibilities

• Manage the contractual process to ensure accurate completion through submission, and prompt response of managed care proposals (letters of interest) and/or other required payors’ paperwork
• Will function as primary liaison for all “regional” payors as defined by the Sr. Manager
• Maintain electronic copies of all signed contracts within the federal, state and local guidelines
• Outline contract provisions including rate analysis for impact
• Assist the Reimbursement team with non-government payor related audits and inquiries
• Review and discuss proposals and responses with Sr. Manager for approval
• Work with System Support to load and test fee schedules and new filing formats for field requirements as soon as the detail is requested and obtained
• Utilizing the Health Plan Contracting Announcement Form will be completed and disseminated as appropriate to all affected personnel within the Company
• Document the terms, fee schedules, and other billing requirements for managed care payor contracts
• Ensure that all fee schedules are updated and current based upon contractual “terms”
• Communicate new and amended contracts to internal departments as necessary
• Routinely audit processes to secure optimal status
• Develop and execute contract documents which align with the annual strategy to ensure that the company’s goals and objectives are met
• Prepare “opportunity” analysis for pricing determinations and opting for in-network/out-of-network managed care
• Evaluate and monitor contracts to determine the overall profitability including renegotiating or terminating contracts if necessary
• Maintain the payor’s participation listing of key contracts for billing and sales teams
• By utilizing existing tools and working with the Billing Management Team, maintain and continue developing solutions to address payor/contract related issues
• Identify possible problem payors/reimbursement trends negatively impacting cash collections
• Educate internal and external clients/customers about any exceptional payer requirements
• Pro-actively pursue payors for contracts based upon volumes, payments, collection percentages, sales team opportunities, and when payers are uninterested, renew angle with educational information to benefit the payor
• Act as a liaison between Billing A/R team and payor relations when contractual related A/R issues escalated
• Will perform other duties as assigned

Skills

Verbal communication

Written communication

Payer dynamics

Contract negotiation

Deadline management

Detail oriented

Multitasking

MS Office

Education

High School Diploma

Tools

Microsoft Office

Contract management software

Job description

Locations

PA Horsham PA101062 Horsham Twp, PA 19044, USA +4 more locations

• Remote
• Administrative
• Full-Time
• Requisition #: PAYOR031356
• Supervisor : Julie Mangine

Description

ROLE:

This position is responsible for managed care contract administration across all Trident business entities. In this role, the Contract Coordinator reports to the Sr. Manager RCM, Payer Strategy directly and works with various Management Team members and Sales team to proactively identify contracting and other business-related opportunities. In addition, the Contract Coordinator will ensure that contracts are analyzed for efficiencies and profitability. Operational Contract implementation and payment auditing with tracking mechanisms to ensure accuracy for each executed contract across all lines of business is vital.

TASKS AND RESPONSIBILITIES:

Manage the contractual process to ensure accurate completion through submission, and prompt response of managed care proposals (letters of interest) and/or other required payors’ paperwork:

Will function as primary liaison for all “regional” payors as defined by the Sr. Manager.

Maintain electronic copies of all signed contracts within the federal, state and local guidelines.

Outline contract provisions including rate analysis for impact.

Assist the Reimbursement team with non-government payor related audits and inquiries.

Review and discuss proposals and responses with Sr. Manager for approval.

Work with System Support to load and test fee schedules and new filing formats for field requirements as soon as the detail is requested and obtained.

Utilizing the Health Plan Contracting Announcement Form will be completed and disseminated as appropriate to all affected personnel within the Company.

Document the terms, fee schedules, and other billing requirements for managed care payor contracts.

Ensure that all fee schedules are updated and current based upon contractual “terms”.

Communicate new and amended contracts to internal departments as necessary.

Routinely audit processes to secure optimal status

Develop and execute contract documents which align with the annual strategy to ensure that the company’s goals and objectives are met.

Prepare “opportunity” analysis for pricing determinations and opting for in-network/out-of-network managed care.

Evaluate and monitor contracts to determine the overall profitability including renegotiating or terminating contracts if necessary.

Maintain the payor’s participation listing of key contracts for billing and sales teams.

By utilizing existing tools and working with the Billing Management Team, maintain and continue developing solutions to address payor/contract related issues.

Identify possible problem payors/reimbursement trends negatively impacting cash collections.

Educate internal and external clients/customers about any exceptional payer requirements.

Pro-actively pursue payors for contracts based upon volumes, payments, collection percentages, sales team opportunities, and when payers are uninterested, renew angle with educational information to benefit the payor.

Act as a liaison between Billing A/R team and payor relations when contractual related A/R issues escalated.

Will perform other duties as assigned.

KNOWLEDGE/SKILLS/ABILITIES:

Excellent verbal and written communication skills

Deep understanding of payer dynamics, including value-based care models and healthcare regulation

Proven track record in contract negotiation and managing end-to-end sales processes.

Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence.

Strong attention to detail

Goal oriented

Able to multi-task in a fast-moving environment and work with multiple deadlines

Proficient in Microsoft Office suite of tools (i.e., Excel, Word, PowerPoint etc.)

EDUCATION/EXPERIENCE:

3 years prior contracting experience

4 years minimum experience in health care billing/accounting required.

High School Diploma required.

Experience with contract management software preferred.

Comprehensive knowledge of managed care for non-government payor relations programs

PHYSICAL DEMANDS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions While performing the duties of this job, the employee is frequently required to talk and to hear. Specific vision abilities required by this job include close vision, depth perception and ability to adjust focus. Employee must have internet access to perform job duties.

WORK ENVIRONMENT:

Qualifications

Skills

Required

Microsoft Office Intermediate

Advanced

Communication Skills Advanced

Computer Skills Advanced

Preferred

Typing Skills Min 35 wpm Intermediate

Behaviors

Required

Team Player : Works well as a member of a group

Detail Oriented : Capable of carrying out a given task with all details necessary to get the task done well

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor.