Payer Relations Coordinator-Full Time-Days

Assist in developing, implementing and maintaining contractual relationships as well as take lead on other projects. Major Job FunctionsThe following is a summary of the major essential functions of this job. The incumbent may perform other duties, both major and minor, that are not mentioned below.

In addition, specific functions may change from time to time:Assist and, in some cases, lead negotiating and maintaining managed care contractsCoordinate reporting that analyze reimbursement methodologies and rates to determine payment accuracyAssist in developing, implementing and maintaining a system of renewal and reporting to monitor the status, performance and viability of contractsWork with internal and external stakeholders to ensure appropriate and timely loading of contract changesMonitor Managed Care websites for any change in policyWork with PFS to determine appropriate claims for escalationWork with Payers on appeals of denialMaintain, monitor and report on managed care recoupment activitiesWork with Client billing lists to ensure contracts are being reimbursedMaintain and validate third-party commercial refund requestsOther duties as assignedMinimum QualificationsThe following qualifications, or equivalents, are the minimum requirements necessary to perform the essential functions of this job:Education and Formal Training: High school diploma or equivalent requiredBachelor’s degree preferred OR 8 years of experience preferredWork

3 years medical business experience in a related field or managed health care experience preferredExperience working directly with employers, insurance companies and/or physicians is strongly preferredKnowledge, Skills, and Abilities Required: Proficiency in reading, writing, and speaking the English languageProficiency with personal computer, electronic calculator, fax machine and copy machineExcellent interpersonal skills with the ability to interact with hospital management, physicians and outside organizationsAbility to be effective with little to no day-to-day supervisionPossess and demonstrate strong written and verbal skills, be results oriented, and exemplify a team player attitudeStrong analytical and financial skills to determine the potential economic impact of relationships, contracts and contract alternativesAbility to demonstrate effective leadership traits and competently execute decisionsAbility and willingness to work on a variety of activities and projectsAbility to work with people in a tactful, diplomatic mannerPhysical

Present a professional and executive image to effectively present proposals and favorably influence clientsPosition requires a flexible scheduleRequired Licenses and CertificationsCape Fear Valley Health System is an Equal Opportunity Employer M/F/Disability/Veteran/Sexual Orientation/Gender Identity