Payor Contract Administrator

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🔥 1 minute ago

🌴 South Carolina – Remote

🌴 South Carolina – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🖥️ Administration

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Prisma Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 2017

🏥 Healthcare

💰 Grant on 2024-08

Healthcare

Prisma Health is a large integrated health system that operates hospitals, clinics, and related patient services in South Carolina and Tennessee. The organization employs nearly 32,000 people and focuses on providing clinical care, nursing and allied health services, and workforce training (e. g. , nurse residency programs), with an emphasis on patient-centered care and community health. The company posts career opportunities across administrative, clinical, technical, and support roles and highlights benefits, hiring events, and candidate resources on its careers site.

📋 Description

• Performs operational and financial analysis to evaluate assigned projects in support of managed care operations, services, and initiatives. • Performs proactive servicing of contracts and analysis of contract performance to include variance support and payor engagement. • Resolves contracting and reimbursement issues. • Prepares findings into summaries and documents suitable for leadership presentation. • Provides managed care education and communication. • Supports the affiliate with resolution of issues related to managed care contracts for facilities, departments and employed physicians. • Responsible for communicating with affiliate and monitoring contractual adjustments, communication of contract policies and procedures, and contract compliance issues. • Works closely with Provider Enrollment to help resolve any payor issues and participates on monthly enrollment calls. • Participates in monthly revenue cycle payor calls. • Assists department leaders on managed care issues with outside organizations such as managed care organizations, the State Hospital Association and other health care providers. • Represents the Affiliate when communicating or meeting with representatives from Managed Care Organizations (HMOs, PPOs, Insurance Networks).

🎯 Requirements

• Education - Bachelor's degree • Experience - Five (5) years of managed care experience. • In lieu of the education and experience requirements noted above, the following combination of education, training and/or experience may be considered an equivalent substitution: Master's degree and two (2) years of managed care experience.

🏖️ Benefits

• Inspire health. Serve with compassion. Be the difference.