Payor Partnerships Enablement Advisor

Remote Opportunity - US Based Candidates

PRIMARY FUNCTIO

NThe 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 RESPONSIBILITI

ESThis list may not include all of the duties that may be assigne

d.
1) 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 integri

ty.
2) 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 mind

set.
3) 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 documenta

tion.
4) 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 document

ation.
5) 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 oth

erwise.
6) Monitors and oversees payor membership and work closely with Revenue Cycle and Finance teams to determine source of truth and remediate any discre

pancies.
7) Maintains an understanding of contractual arrangements and advises payor operational capability to transition across the value-based c

ontinuum.
8) Serves as internal operations point of contact for payor concerns and/or compliance items for joint r

esolution.
9) Other duties a

s assigned.
QU

ALIFICATIO

NSEDUCATION:· Bachelor’s degree in healthcare related field or busines

s preferred

.EXPERIENCE:· Minimum of 3-4 years of combined payor and provider experien

ce required.· Previous healthcare experien

ce required.

KNOWLEDGE, SKILLS

AND ABILITIES· In depth knowledge of claims, credentialing, and load

ing processes.· Knowledge in Risk and Value Base

d Contracting.· Effective organiza

tional skills.· Knowledge of Statewide Medicaid Managed Care programs and Comm

ercial payors.· Advanced Microsoft

Office skills.· Effective oral and written communication and negot

iating skills.· Ability to manage multiple priorities

and projects.· Strong interpe

rsonal skills.· Ability to inf