Atlas Healthcare Partners exists to form strategic partnerships with health systems across the nation to develop, manage and operate Ambulatory Surgery Centers (ASCs) in their markets. As a key player in this rapidly growing healthcare segment, we are committed to providing exceptional care and outstanding customer service to every patient, every physician, every time. Our daily focus revolves around our core values of Integrity, Culture, Teamwork, Respect, and Results.
In addition to fostering a workplace that encourages professional growth and advancement, we provide industry-leading health and dental benefits, paired with a matching retirement package. We look forward to you being a vital part of our journey in shaping the future of healthcare.
Pay Type: Full-Time
Pay Class: Hourly
POSITION SUMMARY
Under the direction of the Manager of Payor Relations, the Payor Relations Representative is responsible for managing relationships with payers, Health System partners, CBO and client ASC’s. The Representative will provide overall support for the regional contracted inventory, including maintaining a shared database with key contract terms, providing accurate and thorough information regarding fee schedules and implementation, payer credentialing and enrollment, products and product changes, and contract measures and metrics, including those pertaining to quality and efficiency. Additionally, the Payor Relations Representative will be responsible for the resolution of questions or concerns from/to payers and for internal constituents through operations support and management.
ESSENTIAL FUNCTIONS

• Responsible for communication to Atlas’ stakeholders of fee schedule updates, contractual requirements, product changes, etc.
• Internal point of contact and champion for ongoing questions from Atlas’ stakeholders (CBO, ASC’s, Atlas’ leadership)
• Responsible for facility credentialing and status reporting to Atlas’ stakeholders
• Responsible for clearinghouse set-up and enrollment process with payers
• Responsible for Provider Portal Administration on the Payer websites
• Maintenance and coordination of contracting documents and the contracting database
• Responsible for contract implementation, including insurance and contract data maintenance in the patient accounting system
• Responsible for payer operational meetings and follow-up
• Key point of contact (externally) for assigned contractual and client relationships
• Ensure new contract terms (including payment terms) for Payer agreements are successfully communicated within the organization.
• Ensure that contracts are properly reviewed, executed, and uploaded into the contract database and shared folders.
• Work cross functionally across key departments to ensure health plans are compliant with rate loading and other operational terms in accordance with contract effective date(s).
• Support contracting initiatives in accordance with Atlas’ business requirements, quality incentive programs and budget requirements
• Responsible for engaging client and CBO leadership to resolve issues resulting from payer related matters to include, but not limited to:
• Research payments, denials and/or accounts to determine short/over payments, contract discrepancies, incorrect financial classes, internal/external errors.
• Facilitates the submission and resolution of payer payment projects on an ongoing basis as directed by the CBO Director or Director of Payor Relations. Manages mass appeals and corrections as necessary with coordination of CBO collections leadership.
• Builds strong working relationships with assigned business units’ staff and leadership, health system partners, CBO leaders. Identifies trends in payment issues and communicates with internal and external customers as appropriate to educate and correct problems. Provides assistance and excellent customer service to both internal and external clients.
• Responds to incoming calls and makes outbound calls as required to resolve payer contract related issues to include billing, payment, fee schedule, payer policies. Provides assistance and excellent customer service to providers, and other internal and external customers.

MINIMUM QUALIFICATIONS

• BS/BA in a relevant field or equivalent relevant work experience is required
• A minimum of three (3) year’s experience in managed care contracting, fee schedule implementation, credentialing, and reviewing of contracts, or an equivalent combination of education and experience.
• Strong communication skills with the ability to communicate clearly both verbally and in writing and be able to articulate complex ideas.
• Strong knowledge in the use of MS Office Suite (Word, Excel, PowerPoint, etc.) software applications, and database software as required

PREFERRED QUALIFICATIONS

• Additional education and experience preferred.
• Credentialing experience preferred.
• Solid understanding of fee schedule development and implementation; demonstrated understanding of health care reimbursement methods and strategies.