1 PAYER RELATIONS REPRESENTATIVE Job in Kankakee, IL
Riverside Medical Center is Hiring a PAYER RELATIONS REPRESENTATIVE Near Kankakee, IL
We Are Hiring!
At Riverside, everyday brings new and exciting challenges. You can expect an interesting environment where you’re part of making sure our organization is running optimally and safely, helping keep the community healthy. We provide the kind of paid training and opportunities that long-term careers are built on and we recognize hard workers who strive to make a difference. You will be able to succeed in our close-knit, safety-focused culture working together as a team. The careers we offer are meaningful because the work we do matters. Join us!
FTE: 1.000000
Shift: Days
Location: Riverside Medical Center
Summary:
The Managed Care Payer Relations Representative works directly with insurance companies to resolve claim disputes between payers and the hospital's Patient Accounts department. M aintains rosters on the hospital's employee health plan and Health Alliance on provider networks. P roduces analytic reports to demonstrate contract effectiveness. Models contract terms and negotiates reimbursement rates.
- Bachelor's Degree required.
- Experience with insurance claims preferred.
- Must be outgoing and results oriented.
- Proficiency in using MS Word and Excel software
- Strong communication and organizational skills
- Understanding of quality measurement systems preferred
- Excellent written and oral communication skills
- Strong organizational and analytical skills
- Experience in supervising other individuals
Responsibilities:
- Assists in fulfilling responsibilities of the department.
- Compiles utilization and financial data on physician/hospital performance under specific contracts for analysis
- Maintains employee and risk-based products physician participation in plans and disseminates information to appropriate insurance companies and hospital personnel.
- Actively engages in advancement/education instruction for self and/or others, i.e. webinars, classes, etc.
- Negotiates contracts with managed care companies for the healthcare system as assigned.
- Provides updates on provider panel numbers for Medicaid MCO plans and processes transfers as necessary.
- Schedules updates for department's PMMC database systems.
- Serves as a liaison between RMC, RMG , medical staff and managed care companies provider relations departments.
- Summarizes plan requirements and preferred providers for distribution to hospital and medical staff. Maintain provider directories and fee schedules.
Essential:
- BACHELOR DEGREE
Riverside Healthcare is revolutionizing care using leading-edge technology to diagnose and treat patients. We are ranked top in the nation for performance in neurosurgery, orthopedics, and heart surgery and have also been named one of the nation's 100 Top Hospitals by Truven Health Analytics seven times. Riverside is nationally recognized for our specialty programs in obstetrics, trauma, oncology, rehabilitation, geriatrics, occupational health, psychiatric services, and treatment of alcohol and chemical dependency, as well as patient safety. We combine innovation and convenience at state-of-the-art facilities located in communities throughout the greater Kankakee area.
Riverside Medical Center proves that truly progressive medicine is being delivered in Chicago's southwest suburbs and East Central Illinois. Join a team that is not only concerned with providing the best care possible but also with offering a work environment of advancement and growth. Riverside is a place that embraces a culture where opinions count and dedications is respected, where superior performance is rewarded with competitive salaries and excellent benefits.
Other information:
Exposure/Sensory Requirements
Exposure to:
Chemicals: Toner for copier and printer, liquid paper, others as listed in department's MSDS.
Video Display Terminals: Extreme
Blood and Body Fluids: None
TB or Airborne Pathogens: None
Sensory requirements (speech, vision, smell, hearing, touch):
Speech: Needed to answer phone and communicate with customers.
Vision: Required to see computer screens, filing, preparing agenda packets and writing minutes.
Smell:
Hearing: Required to answer phones, transcribe from cassettes and communicate with customers.
Touch: Required for operation of computer and phones.
Activity/Lifting Requirements
Average Hours per Week: 40
Shift: Days
Percentage of time during the normal workday the employee is required to:
Sit: 86%
Twist: 1%
Stand: 4%
Crawl: 0%
Walk: 2%
Kneel: 1%
Lift: 1%
Drive: 1%
Squat: 1%
Climb: 0%
Bend: 2%
Reach above shoulders: 1%
The weight required to be lifted each normal workday according to the continuum described below:
Up to 10 lbs: Frequently
Up to 20 lbs: Occasionally
Up to 35 lbs: Not Required
Up to 50 lbs: Not Required
Up to 75 lbs: Not Required
Up to 100 lbs: Not Required
Over 100 lbs: Not Required
Describe and explain the lifting and carrying requirements. (Example: the distance material is carried; how high material is lifted, etc.):Reams of paper are raised from floor to 3' one at a time for storage and back down to table height.
> Maximum consecutive time (minutes) during the normal workday for each activity:
Sit: 180
Twist: 10
Stand: 10
Crawl: 0
Walk: 5
Kneel: 5
Lift: 3
Drive: 5
Squat: 5
Climb: 0
Bend: 5
Reach above shoulders: 10
Repetitive use of hands (Frequency indicated):
Simple grasp up to 10 lbs. Normal weight: 5# frequently
Pushing & pulling Normal weight: occasionally
Fine Manipulation: Stapler, paper, telephone, carts with equipment for lecture.
Repetitive use of foot or feet in operating machine control:
Environmental Factors & Special Hazards
Environmental Factors (Time Spent) :
Inside hours: 8
Outside hours :
Temperature: Normal Range
Lighting: Average
Noise levels: Average
Humidity: Normal Range
Atmosphere:
Special Hazards :
Protective Clothing Required:
To apply please email your resume to hr@rhc.net
Job Summary
Full Time
Ambulatory Healthcare Services
$59k-74k (estimate)
04/24/2023
05/22/2024
rmchospital.com
FRANKLINTON, LA
50 - 100
1966
RICHARD COLON
$10M - $50M
Ambulatory Healthcare Services
Related Companies
About Riverside Medical Center
Riverside Medical Center opened Sunday, April 3, 1966, to provide complete medical facilities for Franklinton and the western portion of the parish. April 3, 1966, the day Riverside Medical Center, a 36 bed acute care hospital was opened, marked the beginning of a new era in modern health care for Franklinton area residents. The Hospital provided the community with modern health care services which enabled residents to stay at home for these services. Also, a very important contribution of the Hospital was the creation of approximately 42 new jobs. Today, the hospital employs over 300 people. ...The original active medical staff of 4 has grown to 31+. Today, Riverside Medical Center is a 25 bed critical access hospital that provides a wide range of health care services important to the health of you and your family. Our dedicated and skilled staff continues to take strides to improve the quality healthcare services to meet the expectation of the families in our community and the surrounding area. Riverside Medical Center is licensed in Louisiana by the State of Louisiana and accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). In addition to our patients receiving a high level of quality care from qualified staff, they are treated with a genuine concern, they are our neighbors. Riverside Medical Center, with its latest technology, offers patients up-to date procedures and treatments in a safe and compassionate environment.
More
Show less
Similar Jobs
Popular Articles
