Position Summary

The Payer Contract Specialist will coordinate the internal contract and rate review process for commercial, governmental, and third party payers.

Essential Job Duties:

• In coordination with Payer Relations Director, works with medical and dental plans to expand company’s network of payers.
• Research and prepare all pre- and ongoing contracting documents (UCR, rosters, etc.) for all commercial payers as necessary.
• Review fee schedules provided by payers prior to implementation to determine impact; prepare practice-facing materials to ensure transparency around contracted rates.
• In coordination with enrollment specialists, maintain database of contracted health plans and provide regular updates to the operations teams regarding network changes, in/out of network status, etc.
• Maintain regulatory information for contracted plans by regular research of provider newsletters and manuals.
• Review and respond to any escalated network issues from payers as well as practice or support center members. Work closely with enrollment specialists to identify and resolve root cause.
• Perform data diligence for prospective payer or network relationships as necessary, including comparison to median rates and practice UCR.
• In coordination with Payer Relations Director, acts as primary liaison to Compliance and General Counsel for initial contract review and approval.
• Tracks eligibility for rate and contract renegotiation; conducts initial and follow-up outreach to payer or practice contract. At direction of Payer Relations leadership, communicates approval and tracks effective date of renegotiated rates/terms.
• Serves as primary liaison for review and execution of No Surprises Act Independent Review (IDR) process. Ensures timely communication with plans regarding rate negotiation, IDR entity selection, and final determination.
• Performs additional duties as assigned by manager or director.

Qualifications and Skills

• Strong working knowledge of managed care contracting, contracting language, insurance networks, and reimbursement methodologies.
• Strong verbal and written communication skills are required.
• Microsoft Office experience is required.
• Excellent analytical, organizational, and problem-solving skills.

Job Type: Full-time

Pay: From $28.00 per hour

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift

Education:

• Associate (Preferred)

Experience:

• Managed care contracting, or insurance networks onment: 2 years (Preferred)

Work Location: One location

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