Offer summary

Qualifications:

Bachelor’s degree in healthcare or business preferred., 3-4 years of combined payor and provider experience required., In-depth knowledge of claims, credentialing, and loading processes., Effective organizational, communication, and interpersonal skills..

Key responsabilities:

Maintain operational relationships with enterprise payor partnerships.

Lead monthly payor meetings and manage operational requests.

Author Managed Care policies to improve operational efficiency.

Develop and maintain payor dashboards for internal stakeholder alignment.

Job description

Primary Function

The Advisor, Payor Partnership Enablement is responsible for internal maintenance of the operational relationship with enterprise payor partnerships. This position is the primary point of contact for process flow creations, payor portal maintenance, data integrity, payor onboarding, resolution management, and communication out of tracked items to enterprise partners. This position works closely with the Director of Contracting & Payor Partnership and the Regional Relationship Managers, and reports to the Director, Payor Partnership Enablement.

Essential Duties And Responsibilities

This list may not include all of the duties that may be assigned.

Supervises roster auditing processes, data integrity, and frequency of provider files being sent to payors to ensure timely credentialing (where applicable), loading, and directory refreshes. Communicates loaded effective dates to internal teams to indicate when patient care can be established and billing can begin. Assists with storage and auditing of provider rosters for payment integrity.
Leads monthly payor meetings for assigned relationships acting as primary point of operational contact for the Pediatric Associates Family of Companies externally. Manages operational requests and coordinates between internal departments for escalation to drive end-to-end resolution. Maintains integrity of relationships with external payor audiences, embodying service excellence and a partner-of-choice mindset.
Authors Managed Care policies to improve overall operational efficiency for payor partners, including but not limited to: payor onboarding, roster submissions, internal department escalations of payor-related issues (e.g. credentialing, revenue cycle, operations), contract storage and maintenance, provider acquisitions, payor notifications and associated timelines, and payor payment integrity. Serves as an internal subject matter expert on Managed Care operations, processes, and documentation.
Develops and maintains payor dashboards for source of truth validation and internal stakeholder alignment, including but not limited to contract terms, external points of contact, payor portal access, establishment and location of automated data feeds and accompanying layouts, value-based performance status, and quality metric documentation.
Oversee all payor portal access, functions, and tools available for applicable use internally. Serves as liaison between Managed Care and IT for ingestion of data feeds, either automated or otherwise.
Monitors and oversees payor membership and work closely with Revenue Cycle and Finance teams to determine source of truth and remediate any discrepancies.
Maintains an understanding of contractual arrangements and advises payor operational capability to transition across the value-based continuum.
Serves as internal operations point of contact for payor concerns and/or compliance items for joint resolution.
Other duties as assigned.

Qualifications

EDUCATION:

Bachelor’s degree in healthcare related field or business preferred.

Experience

Minimum of 3-4 years of combined payor and provider experience required.
Previous healthcare experience required.

Knowledge, Skills And Abilities

In depth knowledge of claims, credentialing, and loading processes.
Knowledge in Risk and Value Based Contracting.
Effective organizational skills.
Knowledge of Statewide Medicaid Managed Care programs and Commercial payors.
Advanced Microsoft Office skills.
Effective oral and written communication and negotiating skills.
Ability to manage multiple priorities and projects.
Strong interpersonal skills.
Ability to influence others.

TYPICAL WORKING CONDITIONS

Non-patient facing.
Full time remote.
Must be U.S. based.
Sitting operating computer for extended periods of time.

Other Physical Requirements

Vision
Sense of sound
Sense of touch

Performance Requirements

Adhere to all organizational information security policies and protect all sensitive information including but not limited to ePHI and PHI (Protected Health Information) in accordance with organizational policy, Federal, State, and local regulations.

PI264903649

Required profile