What are the responsibilities and job description for the Healthcare Payer Relations & Contracting Specialist position at VITAS Healthcare?
The Healthcare Payer Relations & Contracting Specialist holds a pivotal role in fostering positive relationships with healthcare payers and managing effective contracts to ensure fair and timely reimbursement for our hospice company's compassionate end-of-life care services. This multifaceted position requires adept communication, negotiation skills, and collaboration with payers, as well as a commitment to advocating for reimbursement terms that align with our mission and uphold the financial stability of the organization. Must be able to work on-site at the Corporate Miramar, Florida office, Monday through Friday 8am- 5pm. Hybrid schedule.
All duties and responsibilities are to be performed in accordance with VITAS Healthcare Corporation’s policies, procedures, guidelines, contractual commitments, and governmental regulations.
1. Contract Management:
• Draft, review, and negotiate contracts with healthcare payers, hospice service providers, and other partners.
• Ensure that contracts align with the organization's strategic goals and comply with all legal and regulatory requirements.
2. Contract Review:
• Conduct detailed reviews of contract terms, payment rates, and performance metrics to identify areas for negotiation and improvement.
• Collaborate with the Payer Relations & Contracting Manager and legal counsel to address contract-related issues.
3. Payer Relations:
• Assist in maintaining positive relationships with healthcare payers and partners.
• Work with the Payer Relations team to advocate for favorable reimbursement rates and terms.
4. Compliance and Documentation:
• Ensure that all contracts and agreements are accurately documented and stored in accordance with company policies.
• Monitor compliance with contractual obligations, regulations, and accreditation standards.
5. Cross-Functional Collaboration:
• Collaborate with various departments, including Payer Relations, Revenue Cycle, Finance, Operations, and Legal, to support the organization's financial and operational goals.
6. Performance Metrics:
• Track and report on contract performance, including revenue and reimbursement data.
• Work with Payer Relations Specialist to provide regular updates to management on the status of contracts and payer relationships.
• Stay informed about changes in the healthcare industry, payer policies, and regulations affecting hospice care.
7. Payer Relationship Management:
• Cultivate and maintain strong working relationships with healthcare payers, including insurance companies, government programs (Medicare and Medicaid), hospice associations, and other third-party payers.
• Serve as the primary point of contact for both internal and external partners at the health plans, state, and hospice associations.
8. Communication and Collaboration:
• Facilitate regular communication with payers to address inquiries, resolve issues, and negotiate favorable terms.
• Collaborate with internal departments, including Contracting, Credentialing, Revenue Cycle, Operations, Finance and Quality Assurance, to support effective payer relations.
• Assist PR&C Manager collaborations with state and hospice association.
9. Contract Advocacy:
• Work with the Contract Specialist to advocate for favorable contract terms and reimbursement rates during contract negotiation processes.
• Monitor the impact of contract terms on reimbursement and report findings to the Payer Relations & Contracting Manager.
10. Claims and Reimbursement:
• Monitor and track the status of claims escalations, ensuring timely and accurate reimbursement from payers.
• Collaborate with the PR&C Manager and Revenue Cycle team to address payment discrepancies or denials and identify trends.
• Assist the PR&C Manager with the preparation of reports on payer performance and trends for internal stakeholders.
• Provide insights and recommendations for process improvements in payer relations and reimbursement optimization.
11. Compliance and Regulatory Adherence:
• Ensure that all interactions with payers comply with regulatory requirements and industry standards.
• Stay informed and report back changes in payer/state policies, regulations, and reimbursement models to ensure compliance.
12. Continuous Improvement:
• Proactively identify opportunities to enhance the department's efficiency and effectiveness to report back to the PR&C Manager
• Recommend and implement process improvements to enhance contract management and negotiation processes.
QUALIFICATIONS
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.
Experience:
• Minimum of 3 years of experience in contract management, preferably in a healthcare or hospice setting.
• Strong understanding of healthcare payer systems, reimbursement models, and insurance policies.
• Excellent negotiation and communication skills.
• Exceptional relationship-building skills.
• Detail-oriented with strong analytical abilities.
• Ability to analyze data and make data-driven decisions.
• Knowledge of healthcare regulations and compliance standards.
• Proficiency in contract management software and Microsoft Office Suite.
• Ability to work both independently and as part of a team.
• Strong problem-solving skills and the ability to adapt to changing industry dynamics.
Education:
Bachelor's degree in business, healthcare administration, or a related field preferred.
Certification & Licensure:
None required for this position.
Physical Requirements:
Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions of the job.