Payer Contract Specialist Jobs

Payor Contract Specialist

The Payer Contract Specialist will coordinate with managed care to communicate and implement contract changes. Collaborate with facilities and healthcare payers to execute enrollments, manage and maintain proprietary systems, provide documentation maintenance, and monitor communication from payers. They will maintain administrative rights, and set-up new access. The Payer Contract Specialist proactively works with payers, in-house staff, and vendor resources to identify and resolve issues that hinders optimal & timely reimbursement.

Role And Responsibilities

• Review contract files for accuracy of data entry of contract specifications and terms into database and vendor programs.
• Coordinate with EHR/RIS Team on nThrive EDI transactions (837, 835, 270/271).
• Review paper correspondence for opportunities to convert to electronic methods.
• Communicates with facility administrators for CSO access to existing portals.
• Add, maintain, update and apply accurate permissions for CSO and vendor users on payer web portals.
• Create and maintain internal and external portal guides and documentation for features utilized by CSO.
• In coordination with managed care, update and maintain payer grids database of contracted health plans and communicate regular updates to the operations teams regarding network changes.
• Works with automated processes, SFTP transfers, and security.
• Troubleshoot and resolve external or internal user portal issues.
• Additional operational activities including report generation.
• Special projects as required to support CSO/RCM teams
• Review and respond to any escalated network issues from operations teams to managed care to identify and resolve root cause.
• All other duties as assigned.
• Assist facilities with providing current facility billing documentation to health plans and other entities.
• Accurately enroll and maintain access with payers for ERA, EFT, and web portals across the enterprise.

Required Skills:

Preferred Skills

• Experience with EDI files and transactions are preferred.
• Must be detail oriented, organized, self-starter, and have an ability to prioritize workload.
• Ability to analyze and interpret data and solve practical problems in independent and team environments.
• Must be able to handle a wide work variety and work in a fast paced environment.
• General knowledge of Insurance and employee health plan administration.
• Experience with hospital claims processing preferred but not required.
• Ability to work under deadlines and manage multiple projects.
• Must be able to communicate well across all mediums.

Required Experience:

Qualifications And Education Requirements

• 2+ years of previous general healthcare payer experience.
• High School Diploma or Equivalent; Associates Degree Preferred.
• Proficient in working with Microsoft Office, specifically MS Excel, Word, Power Point.
• Strong organizational and interpersonal skills, including the ability to work collaboratively with various colleagues to achieve defined goals
• Self-motivated and results oriented
• Strong oral and written communication skills.
• Ability to apply knowledge of payer contract terminology and payer reimbursement methodologies including managed care requirements and strategies