Scope of Position
The Managed Care Department is responsible for establishing, communicating, and implementing the managed care strategies and objectives for The OSU Health System. The department is accountable for negotiating and managing agreements with managed care organizations. The managed care department advocates for revenue cycle and/or operational improvements identified by Health System departments as it relates to their interactions with managed care plans. The department seeks to improve the financial performance of managed care agreements through improved reimbursement terms, holding managed care plans accountable to contract terms and good business practices, and by identifying and pursuing opportunities to improve the revenue cycle. These goals are pursued with respect to the Health System overall and for each business unit individually. The managed care department functions as a team in accordance with OSU Health Systems strategic plan and departmental objectives.
Position Summary
The Payor Relations Representative is accountable for managing and providing assistance to the various managed care operational and implementation activities within the OSU Health System. This includes ensuring Hospital departments understand their roles and responsibilities in achieving overall contract compliance, working with Hospital departments to improve contract compliance, identifying and facilitating the implementation of Health System and Payor process changes that will improve the revenue cycle, working closely with the Central Business Office on claims payment issues, and coordinating activities with the Manager for Managed Care and Payor Relations. This position has accountability for ensuring that, with respect to managed care agreements, the Health Systems contract management system is accurate and maintained on an ongoing basis, and responsibility for managing financial analysis and reporting from the system.

Minimum Requirements

• Minimum of 4 years experience in managed care (preferably with a health plan in a provider relations role).

• BS in Business, marketing or healthcare, or, equivalent experience.

• Strong verbal and written communication skills required.

• Full comprehension of healthcare issues to effectively deal with administration, other hospital and physician practice personnel and managed care organizations.

• Intermediate knowledge of Medicare and Medicaid reimbursement methodologies. I.e. Resource Based Relative Value System (RBRVS).

• Intermediate level of knowledge of claims processing systems and guidelines.

• Strong social networking and customer service skills- ability to establish a rapport and work well with others.

Our Comprehensive Employee Benefits Include:

• An array of retirement plan options, each with a generous employer contribution.

• Affordable health insurance options, including dental, vision and prescription coverage that begin on day one.

• Paid vacation and sick leave, including short and long-term disability and paid parental leave.

• Get the most out of the Public Service Loan Forgiveness program.

• And much more!