Payer Relations Specialist

The Payer Relations Specialist assists with the administrative oversight of payer contracts on behalf of Springfield Clinic. Works closely with Payer Relations Manager to maintain the details of participating network contracts. Provides internal support so that contractual obligations can easily be met while enhancing revenue and patient access and provides general assistance and support to the Director of Managed Care and Payer Relations Manager.

Job Relationships

Reports to the Director of Managed Care

Principal Responsibilities

• Collaborates directly with the Director of Managed Care and Payer Relations Manager to support all payer relations business needs.
• Possess in-depth knowledge and understanding of payer's guidelines, contractual terms, and the processing of Springfield Clinic claims to provide direction and guidance to all internal departments.
• Responds to payer contract questions as well as benefit and billing questions
• Coordinates with revenue cycle, quality management, practice operations and credentialing teams to ensure that all payer contractual obligations are met.
• Rectifies day to day issues for provider service representatives and others within practice operations
• Receive, research, and perform service recovery as needed
• Maintains relationships with provider relations representatives with all contracted managed care plans.
• Identifies issues to discuss in recurring payer meetings.
• Partner with patient accounting and compliance colleagues to resolve individual cases of improper reimbursement and identify trends.
• Provide verbal and written communication to all applicable Springfield Clinic practice operations, ancillary, and billing teams related to updates of payer information such as payer provider manuals, provider bulletins and other notices relating to eligibility, covered services, pre-authorization requirements, coding and claim requirements, appeal processes, etc.
• Analyze and coordinate execution of single case agreements and requested contracts including communications with other teams.
• Facilitate meetings, display willingness to make decisions within scope of responsibility, and include the appropriate people in the decision-making process.
• Utilize critical thinking and problem-solving skills when addressing payer, office, and provider concerns
• Respond promptly to client needs and solicit feedback to improve service, meet commitments and provide follow-up within a timely manner.
• Develop training aids and train staff on the use of online portals and other tools utilized to obtain prior authorizations in compliance with all payer plans to maximize efficiency
• Build strong relationships and instill confidence and trust at all levels of the organization including providers.
• Attends workshops, seminars, and other training programs for educational growth.
• Comply with the Springfield Clinic incident reporting policy and procedures.
• Adhere to all OSHA and Springfield Clinic training & accomplishments as required per policy.
• Provide excellent customer service and adhere to Springfield Clinic's Code of Conduct and Ethics Standards.
• Perform other job duties as assigned.

Education/Experience

• Associates Degree in business, healthcare administration, or equivalent experience is required. Bachelors degree is preferred.

Knowledge, Skills and Abilities

• Conceptual knowledge of principles and practices of healthcare related payer relations/contracts.
• Strong communication skills are required
• Ability to manage multiple tasks and work in a fast-paced environment is required.
• Must be detail oriented and able to deliver a high level of accuracy.
• Must be proficient in all MS Office applications, including Excel, Access, PowerPoint and Word.
• Ability to define problems, collect data, establish facts, and draw valid conclusions.
• Ability to effectively present information and respond to questions from staff and management across the Clinic.
• Must consistently exercise discretion and sound judgement

Working Environment

• This job operates in a professional office environment.
• Routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.
• Occasional travel possible.

PHI/Privacy Level

HIPAA1