Supports financial analysis and maintenance of managed care contracts, ensures correct payer reimbursement, assists contract negotiations, communicates process changes, and liaises with internal departments to resolve reimbursement, operational, and clinical issues.
The Payor Relations Coordinator is responsible for assisting in the financial analysis, development, and maintenance of managed care contracts. Ensures that payors reimburse FMOLHS and affiliated entities correctly. Acts as a liaison between the Business Office, Medical Management, Revenue Management and other internal departments to resolve identified issues.
Responsibilities1. Managed Care
- Assists in the development and maintenance of financial information related to volume, financial performance, and profitability for each managed care contract. Prepares preliminary interpretations of analysis for project teams, departments and/or management.
- Assists in developing reimbursement strategies and policies and procedures related to contract negotiations.
- Obtains and maintains current information and knowledge of the managed care environment, including but not limited to local, state and national developments; and develops and maintains relationships with appropriate agencies.
- Assists in contract negotiations.
- Ensures that changes in managed care processes are communicated to and followed by FMOLHS and affiliated entity employees in a manner that ensures high quality patient care.
- Strives to promote the quality and efficiency of his/her own performance by remaining current with the latest trends in field of expertise through participation in job-relevant seminars and workshops.
2. Collaboration and Partnership
- Works collaboratively with internal departments (i.e., Financial Operations, Revenue Management, Business Office, etc.) to ensure reimbursement is optimized and to resolve identified issues. Assists in the resolution of identified operational issues with contracted payers. This includes resolution of reimbursement, operational and clinical issues.
- Works with affiliated entities in the development and maintenance of managed care contracts and strategies.
- 3 years professional level hospital or managed care experience
- Bachelor's Degree
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