Managed Care Payor Coordinator

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Location
BHG Bronson Healthcare Group

Title
Managed Care Payor Coordinator

The Managed Care Payor Coordinator is responsible for organizing, monitoring and maintaining payor contracts and relationships on behalf of the Managed Care Department. This position is accountable for monitoring payor compliance to contractual terms, coordinating resolution of payor issues, holding routine payor meetings and annual seminars to facilitate problem resolution and education, developing managed care tools applicable to improving the performance of the revenue cycle process, providing educational resources pertaining to payor activities to internal customers, and championing departmental improvements related to better serving our internal customers. The Managed Care Payor Coordinator serves as the primary contact to lead, triage and/or resolve complex payor-related issues from internal customers, external vendors, governmental agencies and attorneys. This position will take initiative to collaborate with effected internal departments to understand root causes in an effort to improve performance and processes.

The Managed Care Payor Coordinator shall maintain the subject matter expertise relative to the terms and provisions negotiated in Bronson's managed care payor contracts. This position is accountable for developing and building relationships with key revenue cycle stakeholders in order to assist with identifying opportunities to improve reimbursement and achieve departmental goals. The Managed Care Payor Coordinator will have the autonomy to provide internal education and support by developing, managing and implementing programs, resources and tools to inform and guide Bronson employees on payor guidelines, rules and contract terms.

Bachelor's Degree in a related field such as nursing, finance, medical records, patient accounting, or business OR experience equivalent to this degree of at least 15 years in a related field. Background in credentialing and contracting with managed care payors is strongly preferred. Background in patient accounting, billing, contract negotiation or finance administration is preferred.

Advanced analytical and problem solving skills. Understanding of managed care principles, payor contracts and healthcare billing requirements. Strong interpersonal skills, professionalism and cooperative behaviors at all levels of the organization in order to achieve maximum operational effectiveness. Demonstrates initiative to continually enhance understanding of the changing healthcare market. Public speaking skills and expertise in leading teams. Exhibits ability to work independently and is self-directed. Proficient in the use of computer applications. Advanced skills in MS Word and MS Excel programming, and comfortable navigating database queries and management preferred.

Work which produces high levels of mental/visual fatigue, e.g., interactive and repetitive or small detailed work requiring alertness and concentration for sustained periods of time, the operation of and full attention to a personal computer or CRT between 40 and 70 percent of the time.

The job produces some physical demands. Typical of jobs that include regular walking, standing, stooping, bending, sitting, and some lifting of light weight objects.

Excellent verbal and written communication skills are required as this position interfaces regularly with people at all levels within and outside of the organization. Experience with public speaking and presenting to groups is highly preferred. Excellent human relations skills with the ability to work constructively with key revenue cycle process stakeholders, physicians, and office staff is essential.

Essential Duties And Responsibilities

• Organizes, monitors and maintains all Managed Care Payor Contracts, provides input into the negotiation process as a result of feedback from revenue cycle stakeholders.
• Facilitates single case agreements for VP approval.
• Manages the payor contract management database and reporting process.
• Works collaboratively with key stakeholders to coordinate communication of contract terms and provisions.
• Develops and implements a system wide process for educating teams on managed care payor rules and requirements through collaboration and feedback from these teams.
• Develops payor scorecards and/or other reporting mechanisms to monitor overall payor performance in accordance with contractual obligations.
• Coordinates and leads the agenda and materials for routine payor meetings.
• Works with the team to organize and lead annual payor education seminars.
• Researches payor trends and issues, collaborating with internal departments to facilitate resolution.
• Researches medical coverage policies to inform business development efforts.
• Understands key contract provisions for all negotiated payor contracts.

Shift
First Shift

Time Type
Full time

Scheduled Weekly Hours
40

Cost Center
1040 Managed Care Contracting (BHG)

Agency Use Policy and Agency Submittal Disclaimer
Bronson Healthcare Group and its affiliates ("Bronson") strictly prohibit the acceptance of unsolicited resumes from individual recruiters or third-party recruiting agencies ("Recruiters") in response to job postings or word of mouth. Unsolicited resumes sent to any employee of Bronson by Recruiters, without both a valid written agreement with Bronson and a direct written request from the Bronson Talent Acquisition Department for a specific job position, will be considered the property of Bronson. Furthermore, no fees will be owed or paid to Recruiters who submit resumes for unsolicited candidates, even if those candidates are hired. This policy applies regardless of whether the Recruiter has a pre-existing agreement with Bronson. Only candidates submitted through a specific written agreement with the Bronson Talent Acquisition Department for a named position are eligible for fee consideration.
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