Payor Contracting ManagerPrint

Job Summary

The Proliance Surgeons Central Service Office is currently seeking a qualified Payor Contracting Manager.

Job Description

Posted: 10/15/2020
Status: Full Time
Type: Administrative
Care Center: Proliance Surgeons, Inc.
City: Seattle, WA

Proliance Surgeons is one of the largest surgical practices in the country, with over 425 providers including over 250 board-certified physicians providing treatment at more than 100 care centers in Washington State.  Our range of specialties includes orthopedics, sports medicine, spine, ear nose & throat, general surgery, ophthalmology, obstetrics & gynecology, urology and more.

The Central Service Office, in downtown Seattle, is looking for a Payor Contracting Manager to join our team.

 

Position Summary

The Payor Contracting Manager will be responsible for all contract administration, contract verification, and customer support for Proliance Care Centers.  This position will work directly with the payor representatives to resolve payment issues and disputes.  Position will manage 1 FTE.

 

Essential Qualities

The essential qualities necessary include, but are not limited to:

  • Manage but work alongside with as well, our payor contracting specialist.  Position will divide and prioritize the workload of incoming requests from care centers
  • Propose contract rates, structures and terms internally.  Communicate terms with payors
  • Hold quarterly payor meetings, as well as training sessions on various topics with our care centers
  • Maintain Proliance Insurance Manual regarding contract status and referral/auth requirements
  • Manage and monitor accuracy of Experian, a contract management tool
  • Using Excel, Access, or other data analysis tools, develops analyses to support decision making
  • Acts as liaison between corporate and care centers for reimbursement and payer contracting issues
  • Maintains a working knowledge of applicable Federal and State reimbursement laws and regulations as well as payor payment policies and procedures.
  • Identifies changes in regulations and payor policies on a timely basis, identifies the contracts impacted and related financial impact.  Communicates changes to care centers.
  • Interprets contracts, models the fee schedule, loads the fee schedule into our EMR
  • Compiles and maintains charge master
  • Monitors any monthly, quarterly, or yearly changes to CMS fee schedules, calculates the impact to each contract, updates the fee schedules accordingly
  • Reviews claim payments to ensure contract implementations are correct, monitors’ compliance with contractual terms
  • Coordinate with IT and Rev Cycle on special projects and process improvement
  • Attends and participates in internal and client meetings as needed
  • Engages in process and quality improvement activities to minimize manual efforts
  • Performs other duties as required by management

 

Key Duties and Responsibilities

The Pay Contracting Manager is expected to perform position-related duties that include, but are not limited to:

  • Managing but work alongside with as well, our payor contracting specialist.  Position will divide and prioritize the workload of incoming requests from care centers
  • Proposing contract rates, structures and terms internally.  Communicate terms with payors
  • Hold quarterly payor meetings, as well as training sessions on various topics with our care centers
  • Maintaining Proliance Insurance Manual regarding contract status and referral/authorization requirements
  • Managing and monitor accuracy of Experian, a contract management tool
  • Using Excel, Access, or other data analysis tools, develops analyses to support decision making
  • Acting as liaison between corporate and care centers for reimbursement and payer contracting issues
  • Maintaining a working knowledge of applicable Federal and State reimbursement laws and regulations as well as payor payment policies and procedures
  • Identifying changes in regulations and payor policies on a timely basis, identifies the contracts impacted and related financial impact.  Communicates changes to care centers
  • Interpreting contracts, models the fee schedule, loads the fee schedule into our EMR
  • Compiling and maintains charge master
  • Monitoring any monthly, quarterly, or yearly changes to CMS fee schedules, calculates the impact to each contract, updates the fee schedules accordingly
  • Reviewing claim payments to ensure contract implementations are correct, monitors’ compliance with contractual terms
  • Coordinating with IT and Rev Cycle on special projects and process improvement
  • Attending and participates in internal and client meetings as needed
  • Engaging in process and quality improvement activities to minimize manual efforts
  • Performing other duties as required by management

 

Education/Experience/Skills

Education/Experience

  • Bachelor’s degree or greater in Finance, Accounting, Business Administration, Healthcare Management, or related field
  • MBA/MHA preferred
  • Minimum of 5 years’ experience working in payor contracting. 10+ years preferred
  • Experience working in physician practices, hospitals, or ASC’s

Skills/Knowledge/Abilities

  • Knowledge of coding conventions i.e. (Revenue Codes, Occurrence Codes, ICD-9, ICD-10, CPT and HCPCS codes)
  • Knowledge of the various types of health insurance payers: Medicare, Medicare Advantage Plans, Commercial, Medicaid, and Medicaid Managed Care, L&I, Workers Comp
  • Broad ranging knowledge of ASC’s, Clinics, and Ancillary Services
  • Knowledge of healthcare reimbursement methodologies, contract language
  • Understands the fundamentals of billing
  • Strong analytical skills and familiarity with common data analytics tools including Excel, Access, or other analytics tools.  Experience with Business Intelligence tools would be a plus
  • Ability to communicate effectively using data with all levels of the organization
  • Self-motivated team player able to multi-task and prioritize
  • Ability to work independently, multi-task

 

Work Environment/Physical Demands

The work environment/physical demands described here are representative of those that must be met by an associate to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

  • Sitting for extended periods of time
  • Manual dexterity required for use of computer keyboard
  • This position may be stressful at times
  • Working 40 hours per week. Some responsibilities may require longer work hours in order to complete assignments

This description is intended to describe the essential job functions, the general supplemental functions and the essential requirements for the performance of this job.  It is not an exhaustive list of all duties, responsibilities and requirements of a person so classified.  Other functions may be assigned and management retains the right to add or change the duties at any time.

Benefits

Proliance Surgeons offers a generous benefits package including Medical/RX, Dental, Vision, 401k with profit sharing and more! Plus ALL of our employees enjoy the free perks of our employee purchasing program offering a variety of discounts on purchases made every day – including cell phone service!

Proliance Surgeons is proud to be an equal opportunity employer. We are committed to creating an inclusive environment, and we welcome and encourage people of all backgrounds, perspectives, experiences, and skills to apply.

All employment decisions at Proliance Surgeons are based on business needs, job requirements and individual qualifications, without regard to race, color, religion or belief, national, social or ethnic origin, sex (including pregnancy), age, physical, mental or sensory disability, HIV Status, sexual orientation, gender identity and/or expression, marital, civil union or domestic partnership status, past or present military service, family medical history or genetic information, family or parental status, or any other status protected by the laws or regulations in the locations where we operate. We will not tolerate discrimination or harassment based on any of these characteristics. 



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