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Senior Payor Relations Specialist

Company: Boston Children's Hospital
Location: Boston
Posted on: August 7, 2022

Job Description:

This Senior Payor Relations Specialist will be responsible for Acting as a liaison between the Enterprise and managed care carriers. Working to resolve issues, build cooperative relationships with a wide range of payers. Tracking and monitoring payers following established policies and procedures. Identifying and working to resolve recurring instances of reimbursement issues and trends. Contacting payers regarding disallowed payments and resolves payments and reimbursements where there is a trend or established pattern which is lower or different than the agreed-upon contractual provisions. Escalating unresolved issues with significant impact to the Enterprise to management or others if initial efforts do not resolve issue or large magnitude situations that warrant immediate management intervention. Supporting the Contract team by supporting the Enterprises operational areas during contract negotiations by identifying opportunities to enhance the operational efficiency of managed care relationships through contract language revisions, including and auditing of payer agreements. Ensuring terms are loaded into internal Enterprise systems in accordance with resolution of significant issues between the Enterprise and the carrier/payers, negotiated agreements for government programs such as Medicaid reimbursements, and Single Case Agreements or international operations. Auditing system to ensure payer agreements are loaded in the system including processes, schedules, and related information. Keeping abreast of and identifies payer plans where the Enterprises participation is included/excluded, determines the impact of inclusions/exclusions on the Enterprise, and communicating the situation and impact within the Enterprise. Monitoring managed care carriers, Accountable Care Organizations, and MassHealths payor policies and benefit inclusions/exclusions and raises areas of concern to leadership as needed. To qualify you must have Knowledge of theories, principles, and concepts typically acquired through the completion of a Bachelors degree in business administration, accounting or finance, or a closely related field, plus three to four years of previous directly related experience; Ability to analyze, research and synthesize MassHealth regulations and guidance as well as Managed care carriers/Accountable Care Organizations (ACO) payment policies and provider manuals. Broad knowledge of physician/healthcare billing practices, coding, and contract implementation processes, and terms and definitions related to reimbursements and payments; Analytical skills to collect information from diverse sources, apply professional methodologies and principles in performing various analyses, and the ability to summarize information and data to identify and resolve problems; Communication skills to effectively communicate both orally and in writing, and to employ empathy and tact in difficult interpersonal situations and in conflict resolution; Ability to work with diverse internal and external constituencies.

Keywords: Boston Children's Hospital, Boston , Senior Payor Relations Specialist, Accounting, Auditing , Boston, Massachusetts

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