Payor Relations – Contracting Specialist

Job not on LinkedIn

🔥 0 minutes ago

🌽 Illinois – Remote

🌽 Illinois – Remote

💵 $26 - $44 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Carle Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1946

⚕️ Healthcare Insurance

🏥 Healthcare

📚 Education

Healthcare Insurance • Healthcare • Education

Carle Health is a comprehensive healthcare provider dedicated to managing the health needs of its community. Offering a wide range of services, from general medical care to specialized treatments in oncology, cardiovascular, pediatrics, and women's health, Carle Health emphasizes quality patient care and community health initiatives. Additionally, it supports education and research through the Carle Illinois College of Medicine and engages in community health programs that aim to improve overall well-being.

📋 Description

• Coordinate payor contracting processes for Carle Foundation entities, including hospitals, ancillary services, provider groups, and ambulatory surgery centers • Develop and maintain information for monitoring and reporting payor contract rates and terms • Coordinate payor and provider contracting programs • Ensure compliance with contract terms, including renewal and termination provisions • Cultivate relationships with payors and manage payor and internal department inquiries • Research claims reviews and provider load issues • Maintain a managed care contract database and track annual renewals • Facilitate Payor Escalation meetings with Revenue Cycle Staff • Support contracts from initiation through implementation and completion • Gather administrative and clinical department input on new and amended contracts • Manage action items from monthly Payor meetings with billing, case management, and provider enrollment teams • Coordinate communication of payor changes, including Epic system and training requests • Serve as liaison and subject matter expert on contracting, payor relations, and reimbursement discrepancies • Map new plan codes and participate on the Payor Plan Code committee • Manage annual charge increases and contractual impacts • Obtain, maintain, and distribute payor fee schedules • Review contract language and payor policies to determine reimbursement for new procedures and services • Coordinate facility recredentialing data collection • Collaborate with billing, coding, and compliance teams to ensure accurate and timely claim submissions • Ensure compliance with federal, state, and local regulations and industry best practices

🎯 Requirements

• Associate's Degree (Required) • Experience in medical payor work • Knowledge of payor contracting processes and reimbursement methodologies • Ability to review contract language and payor policies • Ability to manage payor relations, billing disputes, and reimbursement discrepancies • Ability to maintain contract databases and track renewals • Ability to coordinate with billing, coding, compliance, clinical, and administrative teams • Knowledge of Epic revenue cycle systems and training request processes • Understanding of claims submission, provider enrollment, facility recredentialing, and plan code mapping • Ability to ensure compliance with federal, state, and local regulations

🏖️ Benefits

• Comprehensive benefits package • Day shift • Monday–Friday schedule • No weekend requirements • No holiday requirements • No on-call requirements