Payer Relations Contracts Consultant

Number of Job Openings Available:

1

Date Posted:

December 05, 2024

Department:

16001461 Payer Relations & Contracting

Shift:

Day (United States of America)

Shift Length:

8 hour shift

Hours Per Week:

40

Union Contract:

Non-Union

Weekend Rotation:

None

Job Summary:

Allina Health is a not-for-profit health system that cares for individuals, families and communities throughout Minnesota and western Wisconsin. If you value putting patients first, consider a career at Allina Health. Our mission is to provide exceptional care as we prevent illness, restore health and provide comfort to all who entrust us with their care. This includes you and your loved ones. We are committed to providing whole person care, investing in your well-being, and enriching your career.

Key Position Details:

The Contract Consultant serves as an interface between health plans and Allina business units to coordinate efforts in the evaluation, prioritization, and resolution of service issues. Develops communications and engages impacted staff regarding health plan policy and procedure changes by monitoring newsletters and other publications.

Monitors contractual obligations working closely with Directors and Contract Managers to ensure compliance. Supports assessment of the impact of contract terms to business units, advocates for changes into agreements where necessary to support administrative simplification. 

Researches escalated claims issues to determine whether claims processed in accordance with health plan agreement; requires understanding of how to read a claim, basic coding, payment methodologies, and application of health plan coverage policies.

Supports Directors and Contract Managers who lead most health plan negotiations. This role leads contracting efforts for single case and county agreements. Leads the evaluation of new payer agreements. 

This position has broad visibility across many service areas and accountability as a team player with various levels within the organization.

Job Description:

Serves as an interface between payers and company business units in the coordination of service delivery. Maintains awareness, develops communications and engages impacted staff regarding health plan policy and procedure changes by monitoring newsletters and other publications.

Principle Responsibilities

• Interface for service delivery
  • Monitors contractual obligations working closely with designated directors and contract managers to ensure compliance.
  • Supports assessment of the impact of the contract terms to business units and advocates for changes into agreements where necessary to support administrative simplification.
  • Researches escalated claims issues to determine whether claims are processed in accordance with the health plan agreement.
• Business development
  • Assists in the development of strategies to improve overall payer performance.
  • Leads the evaluation of new payer agreements.
  • Leads the contracting efforts for single case and county agreements.
• Other duties as assigned.

Required Qualifications

• Bachelor's degree in Finance, Business Administration Management or related field, or, currently working toward a degree in one of these fields
• 2+ years of business experience
• Understanding of how to read a claim, basic coding, payment methodologies and application of health plan coverage policies

Preferred Qualifications

• Health care experience with an understanding of billing and payment methodologies

Physical Demands

• Lifting weight,