Sr. Payor Relations Specialist

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.

Provides senior level support to the managed care team and is serves as a subject matter expert on a wide variety of concepts, practices and procedures necessary to meet the goals of the department. The Senior Payor Relations Specialist will work closely with each contract manager and will support the various aspects of a complex negotiation or relieve the manager with lower priority negotiations as needed. The Senior Payor Relations Specialistwill be particularly focused on the management of network status of our hospital, professional and ancillary service lines with the most complex payor relationships. The Senior Payor Relations Specialist is responsible for training and mentoring other Managed Care staff and shall represent the department as the authority on providing guidance on complex claims issues, payor relationship management and process improvement development.

PRIMARY DUTIES AND RESPONSIBILITIES

1. Support Contract Manager and actively participate in complex payor negotiations; Payor Relations Specialists Senior may independently manage less complex or lower priority negotiations
2. Serve as lead trainer and subject matter expert on complex claims issues, problem solving and payor relationship development
3. Develop training tools new hires and other Payor Relations Staff; provide support and guidance to other staff members
4. Strategize with Contract Managers on best practices to be established and take lead role in implementing those practices witin the department
5. Create policy and procedures for process improvement opportunities within department
6. Independently support the department's communications with credentialing, billing, practice management, business office, and other departments for assigned payor relationships.
7. Independently interpret and disseminate provider newsletters, payment policies, administrative guidelines and plan identification ID card compliance to business office and other support areas
8. Support the Contract Manager in reviewing Chargemaster and Rate Escalator changes to determine the necessary rate changes to be implemented within Contract Manager
9. Maintains Contract Manager Tool to accurately reflect rate changes for hospital, ASCs and professional fee schedules
10. Represent Northside in a professional manner and maintain positive relationships with key payor contacts.
11. Independently research, analyze and resolve claim issues with timely follow up and professional communication.
12. Manages miscellaneous ad hoc research and cost analysis projects in support of the Managed Care Department negotiations.
13. The Payor Relations Specialist will work directly and independently with Payors to monitor progress on Joint Operating Committee meetings.

REQUIRED:

1. Bachelors Degree or equivalent work experience of no less than 5 years in the area of provider relations.

2. Strong understanding of hospital reimbursement methodologies.

3. Strong understanding of activities, practices, tools and considerations for managing the claims adjustment process.

4. Experience with contract modeling software.

5. 2 years of Negotiation experience.

6. Ability to work independently.

7. Strong analytical skills.

8. Excellent organizational skills.

9. Excellent communication skills.

10. Strong working knowledge of computer spreadsheet programs and database programs such as Access

PREFERRED:

1. McKesson/HBOC Trendstar CPA

2. Microsoft Excel and Access