Payor Relations Lead - Dallas, TX

Be part of our team and make a difference in the lives of allergy sufferers!

Who we are:

At United Allergy Services, we are a national allergy services and pharmaceutical business which partners with practitioners in over twenty states to provide on-site allergy testing and treatment options; aiming to revolutionize allergy care and expand access to millions who would otherwise go without it.

Your future role:

As a Payor Relations Lead, you will play a crucial role on our payor relations and revenue cycle support team and in our mission to provide accessible allergy care by helping the business with payor relations strategic relationships, monitoring and responding to regulatory policies, transactional payor activities and projects and influencing payor decisions. 

Key responsibilities:

• Responsible for assisting in the identification, development and coordination of strategic relationships with payors and organizations that influence payor decision-making.
• Continuous monitoring of federal, state, and payor policies that impact reimbursement of supported services.
• Execute ongoing and ad-hoc reporting requests and other project assignments issued by Revenue Cycle and Payor Relations.
• Responsible for continuous system and data integrity maintenance to ensure leadership can be confident in data driven decision making.
• Completing transactional case work on a day-to-day basis, with a focus on training and quality assurance of Tier 1 case workers, and review and delivery of guidance for Tier 2 issues.

Detailed Responsibilities:

• Learn and demonstrate intimate knowledge of UAS processes to proficiently train and support QA Tier 1 case workers and offer guidance for Tier 2 health insurance claim and payor issues.
• Consistently monitor federal, state, and payor policies that impact reimbursement of supported services.
• Maintain UAS system and data integrity via continuous monitoring and analysis of user inputs.
• Assess and execute ongoing and ad-hoc reporting requests from multiple teams and departments in a timely and effective way.
• Assists with the identification, development, and coordination of strategic relationships with payors and organizations that influence payor decision-making.
• Performs other related duties and projects as required or assigned.

Skills and Abilities:

• Communications: 
  • Must speak English clearly and fluently to communicate on a wide range of topics. Average adult reading comprehension, and grammatically correct written communication skills.
  • Ability to understand and respond intelligently to business correspondence. Interpersonal skills as needed to persuade, manage conflict, debate and negotiate. 
  • Response to pressure should be calm and reasonable.
  • Professional presentation skills.
• Computer Literacy:
  • Advanced level competence with MS office (Outlook, Excel, Word, OneNote).
  • Customer Relationship Management (CRM) system experience is preferred.
  • Experience with virtual communications tools, such as Teams, Zoom, Webex, etc. is preferred.
• Judgment: 
  • Comprehension of job requirements and procedures.
  • Can initiate and perform work assignments under minimal supervision and in a virtual self-directed setting, which may be broad, varied, and complex in nature.
  • Recognition of out-of-tolerance situations with appropriate action taken. Able to choose the correct course of action from a given set of variables. Ability to use educated and intuitive judgment to make decisions with limited direction.
• Analysis: 
  • Mathematical aptitude; extensive use of numeric calculations in audit, research, and compilation tasks.
  • Meaningful and accurate assessment and summarization of data and information.
• Organization: 
  • Management of concurrent projects within budget & time constraints and complete tasks in a timely manner.
  • Organizational and time management skills are sufficient to plan and accomplish assigned goals.
• Logic: 
  • Deductive reasoning ability to enable the appropriate application of general concepts to specific situations.
  • Able to translate theory into business practices. Inductive reasoning developed sufficiently to enable comprehension and use of statistical values as required for analysis and evaluation. Able to apply technical information to identify problems and plan strategic resolutions.
• Management: 
  • Mastery of the typical disciplines of a leader, consistent with work of an independent contributor, including planning, evaluating, organizing, and controlling. Ability to effectively motivate others to achieve objectives. Must be able to solicit feedback as well as give direction to others.
• Physical: 
  • Must be able to be available and work at a desk and computer for multiple hours per day and access and function within areas key to productivity.
  • Physical ability to move around within and between facilities and conduct meetings.
  • Adequate manual dexterity to operate assigned and shared office equipment.
  • Ability to travel on periodic overnight and extended stays via car or airline and work extended hours when necessary. Travel is estimated to be 5% of the time or less.

Qualifications:

• Education:
  • Bachelor’s degree in business or other commensurately equivalent program or five (5) to seven (7) years of recent and equivalent work experience in payor relations role.
• Background & Expertise:
  • At least three (3) years’ experience in a healthcare and/or health insurance related environment is required.
  • In depth understanding of healthcare benefits (HMO, PPO, ACO, Medicare, Medicaid, etc.) is required.
  • Basic understanding and experience with Revenue Cycle Management.
  • Prior personal health claim billing and coding experience is required.
  • Comprehensive knowledge of standard medical documentation requirements, Insurance appeal process, EMR systems, and experience with Salesforce will aid with success.
  • Experience in public speaking and able to present to and manage meetings and communications with large groups.
  • Health insurance claim submission and appeals process, with an emphasis on denial and recoupment resolution efforts.

Benefits:

• PTO and Company Holidays
• Medical (PPO & HDHSA), dental, vision, and life insurance are available.
• Company 401(k) retirement plan with match.
• Employee Assistance Program (EAP)
• Daytime, business week schedule.
• Ability to work virtually first most of the time.