Sound Physicians

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Payer Contracting Negotiator

at Sound Physicians

Posted: 9/21/2019
Job Status: Full Time
Job Reference #: c34d2490-9bf3-42aa-b212-36473d23c110
Categories: Sales
Keywords:

Job Description

Position Summary

Under the supervision of the Director of Payor Contracting, the Payor Contracting Negotiator is responsible for all duties related to managed care contracts. This position works closely with the Payor Contracting and Payer Enrollment team to ensure all contracts are appropriately identified, negotiated, implemented, audited and renegotiated in a timely manner.

Essential Duties and Responsibilities

  • Responsible for the development, coordination and analysis of managed care contracts
  • Negotiates reimbursement and language of payor contracts
  • Addresses operational issues and reviews contracts and terms in order to facilitate implementation
  • Responsible for identifying managed care opportunities in the marketplace
  • Establishes productive personal relationships with payor reps
  • Understand and communicate contract specific issues of all payors
  • Ensure all documents associated with the negotiated payor agreement are in the systems correctly at all times and performs random audits on a regular basis to ensure same  
  • Works closely with Payor Contracting team to ensure timely notification of changes to payors
  • Provide weekly contract status updates
  • Provide other reports as directed by Director
  • Manages the planning process for contract renewals and negotiations including assessment of historical performance and issues as well as identification of payor specific issues
  • Identify opportunities and recommendations for specific payors
  • Assist with analysis of Payor Mix info and utilization
  • Proactively identify, research, understand and present issues that impact Sound Physicians and partner facilities to Payor Contracting Director
  • Working knowledge of Billing Database for reporting purposes
  • Other duties as assigned 

Special Knowledge, Skills, Abilities, Training or Special Licenses/Certifications needed to perform this Job

  • Able to handle multiple tasks simultaneously, meet time sensitive deadlines and organize workload with limited supervision
  • Must have a working knowledge of current policies and guidelines that affect contracts, pricing, rebates etc. in the managed care environment
  • Working knowledge of Payer Enrollment structure and processes
  • Current working knowledge of Medicare reimbursement methodologies, fee schedule development, utilizing financial models and analysis in negotiating rates with payors
  • Knowledge of claims processing systems and guidelines
  • Excellent organization abilities as well as written and oral communication skills
  • Creative and persistent problem solver
  • Attention to detail and accuracy
  • Client/service oriented (internal and external)
  • Maintain strict confidentiality of sensitive information
  • Ability to interact and communicate with individuals at all levels of organization
  • Ability work in a group setting
  • Ability to complete projects independently within established time frames
  • Proficiency with Microsoft Office Suite
  • Proficient typing skills

Education

  • Bachelor’s degree with Managed Care, Payor or Provider Contracting  
  • Preferred – 5 years Payor or Providing contracting negotiations experience
  • Required - Advanced understanding/knowledge of computer data entry, SharePoint, Microsoft Excel and ability to navigate through any business related software

 Special Job or Environmental Conditions

  • Indoor office environment
  • Some travel required

Other Physical and/or Special Requirements about this job:

  • Sitting at a desk up to eight hours (with breaks)
  • Working on computer for up to eight hours (with breaks)
  • Moving/lifting file boxes (up to 25 lbs)