Payor Contract Administrator

This is a fully remote position, open to applicants in South Carolina.

📋 Description

• Conducts operational and financial analyses to assess designated projects in support of managed care operations, services, and initiatives.

• Engages in proactive contract servicing and performance analysis, including variance support and payor engagement.

• Addresses and resolves contracting and reimbursement challenges.

• Compiles findings into summaries and documents that are suitable for presentation to leadership.

• Delivers education and communication related to managed care.

• Assists the affiliate in resolving issues pertaining to managed care contracts for facilities, departments, and employed physicians.

• Manages communication with the affiliate, monitors contractual adjustments, and ensures adherence to contract policies, procedures, and compliance issues.

• Collaborates closely with Provider Enrollment to address payor issues and participates in monthly enrollment discussions.

• Engages in monthly revenue cycle payor calls.

• Aids department leaders with managed care concerns involving external organizations, including managed care organizations, the State Hospital Association, and other healthcare providers.

• Acts as a representative for the Affiliate during communications or meetings with Managed Care Organization representatives (HMOs, PPOs, Insurance Networks).

⛳️ Requirements

• Education - Bachelor's degree.

• Experience - Five (5) years of managed care experience.

• Alternatively, a 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.