Managed Care Payor Specialist - Located in Lewisville, TX

Located in Lewisville, TX

Job Description

Managed Care Payor Specialist

Location: Remote United States

Annual Compensation: $70,000 - $80,000 DOE

Work Schedule: Full-Time

The Managed Care Payor Specialist works within the Managed Care Department responsible for the Open Negotiation Process including initiation and on-line response/negotiations. In addition, this position will be responsible for the Contract Database, documenting contract terms, requirements with agreements, working closely with Managed Care Directors and Revenue Management.

Essential Functions/Duties

• Initiate all claims eligible for Open Negotiation Process.
• Review any rejected emails or issues with Open Negotiation to assure prompt resolution and correction within the ONP initiation period.
• Review all payor responses to Open Negotiation, entering data into Appian including copies of secure email.
• Negotiate within the established guidelines for settlements.
• Work with NSA legal, RCM, Managed Care, and NSA project team to assure smooth administration making recommendations for improved processes.
• Maintain and develop contract database including accurate documentation of contract terms, pricing, renewal dates and attachment of contracts, amendments and manuals.
• Work with Managed Care team and Revenue Cycle teams to resolve issues with contract database to assure accurate compliance with agreements.
• Communicate with cross functional teams regarding insurance industry updates and changes.
• Research provider manuals and billing requirements to ensure guidelines meet claim resolution solutions.
  
  

Qualifications

Required Experience:

• Fluent in English
• 2 years’ experience working in a managed care, payor relations, or experience working with health insurance contracts
• Strong computer skills with experience in various software packages, including Microsoft Suite and web-based applications
• Knowledge of healthcare/medical billing/coding and insurance medical policy interpretation
• Demonstrated strong follow through skills
• Ability to work and adapt to a fast-paced environment and manage multiple projects while maintaining a high level of attention to detail
  
  

Education

• College Degree Preferred
  
  

Skills

• Requires strong problem-solving skills and attention to detail
• Ability to work independently with limited supervision
• Excellent written and verbal communication skills
• Team Player
• Negotiation with insurance carriers
  
  

Why Choose GMR? Global Medical Response (GMR) and its family of solutions are dedicated to delivering compassionate, quality medical care, primarily in the areas of emergency and patient relocation services. Here you’ll embark on meaningful work that will make an impact on you and the customers we serve. View the stories on how our employees provide care to the world at www.AtaMomentsNotice.com.

GMR’s Core Behaviors—keep care at the center, raise your hand, seek to understand, find a way together and be accountable—unite our teams and set us apart in emergency medical services.

EEO Statement

Global Medical Response and its family of companies are an Equal Opportunity Employer, which includes supporting veterans and providing reasonable accommodations for individuals with a disability.

More Information About This Job

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