1 Health Plan Liaison & Insurance Contrast Specialist Job in Southlake, TX

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Health Plan Liaison & Insurance Contrast Specialist

Complete Care ER

Southlake, TX | Full Time

$82k-104k (estimate)

2 Months Ago

Health Plan Liaison & Insurance Contrast Specialist

Complete Care ER Southlake, TX

$82k-104k (estimate)

Full Time 2 Months Ago

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Complete Care ER is Hiring a Health Plan Liaison & Insurance Contrast Specialist Near Southlake, TX

Full-time Health Plan Liaison & Insurance Contract Specialist -

Southlake, Texas

**This is an onsite position only, not remote.**

Must have a minimum of three years healthcare industry experience, with an emphasis on contract negotiation and administration, required.

Must have an In-depth knowledge of revenue codes, CPT codes, and HCPCS codes

We are looking for our next SUPER STAR! As a Payor Relations & Contract Specialist at Complete Care, you will be responsible for implementing policies, negotiating rates, and language terms with regard to provider enrollment with insurance plans and managed care contracting. If you are looking to join an award winning company with a great work environment and friendly outgoing co-workers then keep reading.

About us

Complete Care values the role each member of our team plays in helping provide award winning care to the communities we serve. We employ more than 500 people and provide rewarding career opportunities that help them reach their highest potential. You’ll be recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role.

Our company has been industry pioneers since 2009. We have been recognized year after year by receiving the prestigious Press Ganey Pinnacle as well as the Guardian of Excellence award for patient satisfaction.

“The only way to earn the accolades we’ve received is to hire great people and give them the tools to succeed. I am fortunate to be surrounded by a very talented team. When people take pride in their work and love their job, extraordinary things can happen” –Rob Morris, CEO

RESPONSIBILITY:

Collaborate with leadership, identify appropriate contracting and re-contracting opportunities.
Initiates discussions with key constituents as related to new relationships or service lines.
Performs business and market analysis to determine viability of contracting.
Ensures contracting efforts remain aligned with company goals; contract terms can be administered and monitored in a cost-effective manner.
Collaborates with payors and internal stakeholders to gain a thorough understanding of payer-specific requirements, reimbursement logic, and limitations.
Leads contract discussions with managed care organizations, including rate and language negotiations in accordance with established guidelines. Leads development of rate and language proposals.
Collaborates with internal staff on modeling of rate proposals.
Confidently make sound recommendations to leadership for accepting/rejecting proposed managed care agreements.
Effectively interfaces with management, clinical, operations, and administrative staff to ensure contract negotiations are completed in accordance with critical dates and within approved financial parameters.
Manages all aspects of the contract life-cycle; reviews and evaluates contract language and reimbursement terms.
Updates and models with new contract and reimbursement terms using proprietary software applications and MS Office tools.
Collaborates to assemble and gain an understanding of payer specific data, operational issues, and business review.
Prepares financial analyses and reports.
Implements executed contracts cross-functionally, communicates contract changes internally, maintains appropriate documentation, reviews contract performance reports and makes appropriate recommendations.
Facilitates problem solving of escalated contractual and operational issues through collaboration with managed care organizations and internal stakeholders.
Identifies and communicates opportunities for process improvement with managed care organizations and internal stakeholders.
Coordinates with analytical team to ensure contractual terms, including payer-specific requirements, reimbursement logic, and limitations are understood and appropriately included in any modeling systems.
Serves as the expert on all terms of the payer contract for both internal and external parties.
Participates in special projects as needed, including evaluating feasibility of program development as it pertains to payer operational requirements and reimbursement policies
Stays abreast of changing healthcare landscape to maintain an awareness of competitor services and reimbursement models, as well as opportunities for improvement in the financial and operational components of managed care contracts.
Leads discussions pertinent to contract performance, market changes, market intelligence, and strategic decision making.
Performs miscellaneous job related duties as requested.

MINIMAL REQUIREMENTS:

High school diploma required; Associates Degree preferred.
Minimum three years of healthcare industry experience, with an emphasis on contract negotiation and administration, required.
In-depth knowledge of revenue codes, CPT codes, and HCPCS codes
Proficient in Microsoft Excel, Word, Outlook, PowerPoint and Internet
Excellent written and oral (presentation) skills.
Strong analytical and project management skills.
Ability to work both independently and in a dynamic team environment with rapidly changing priorities and demands.
Ability to prioritize and handle multiple tasks in a demanding work environment.
Demonstrated organizational skills. Ability to work effectively under deadlines and produce accurate work.
Ability to communicate complex issues effectively.
Demonstrated ability to drive results and take initiative.
Strong understanding of the insurance environment, including, but not limited to, insurance policies and procedures, reimbursements mechanisms, billing principles, and practice management/medical office procedures.
Maintain confidentiality and privacy is a must.