Payor Contract Administrator

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🌴 South Carolina – Remote

🌴 South Carolina – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🖥️ Administration

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Prisma Health

WebsiteLinkedInAll Job Openings

10,000+ employees

⚕️ Healthcare Insurance

Healthcare Insurance

Prisma Health is a comprehensive health care provider offering a wide range of medical services to ensure individuals achieve their healthiest state. With numerous locations, advanced technology, and expert specialists, Prisma Health provides accessible and convenient care. Services include primary care, specialized heart, cancer, women's, and children's health, as well as same-day and telehealth options. Prisma Health emphasizes community outreach and education to support overall health and wellness.

📋 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. • Escalates issues that impact company goals. • Works closely with Provider Enrollment to help resolve any payor issues and participates on monthly enrollment calls. • Schedules and participates in meetings with affiliate administrators, directors, and medical directors on issues related to managed care contracting strategies and provides ongoing education and communication of local and national managed care trends. • Works closely with facility and physician revenue cycle departments to remediate contractual issues and assist in facilitating reimbursement related issues as they arise. • 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). • Supports management and interacts with Directors or Vice Presidents when conducting business with managed care organizations. • Responsible for assisting in and maintaining and enhancing relationship with managed care organizations. • Supports and delivers educational programs and seminars for staff, provider personnel and clients. • Assists as needed with projects of significant scope that have Affiliate implications. • Performs other duties as assigned.

🎯 Requirements

• Bachelor's degree • Five (5) years of managed care experience. • Master's degree and two (2) years of managed care experience may be considered as equivalent substitution.

🏖️ Benefits

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