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Payer Relations Manager

Company: BayMark Health Services
Location: Lewisville
Posted on: November 19, 2022

Job Description:

NSC Payer Relations Manager BayMark Health Services is looking for a Payer Relations Manager to report to the Sr. VP of Payer Relations and Contracting (PRC) as is part of the PRC Business Development team.Payer Relations Managers focus is to collaborate with IT to develop payer database management system and monitoring of all payer agreements; analyze, prepare new and renegotiated contracts/addendums/applications and facilitate through the Contract Approval Process routing; lead internal contract implementation and act as liaison to facilitate their cross departmental execution (through Credentialing, Business Operations, RCM, and Marketing); participate in new acquisition payer due diligence research and report development.In addition to performing day-to-day Payer Relations Contract Manager functions, this role will also be instrumental in helping the organization conduct analyses and projects to support the decision-making process of the business development initiatives fostering cooperative, collaborative environment where everyone works together toward common goals.Essential Job Functions

  • Facilitates and tracks requests to Credentialing for credentialing paperwork submissions required to complete payer enrollment and contract execution. Provides credentialing updates to PRC team.
  • Tracks requests to RCM and monitors to confirm completion of contract term loading through billing set up (coding, rates, COLA increase set up). Provides updates to PRC team
  • Drafts responses and fulfills requests for additional information needed by managed care plans representatives when requested.
  • Assist in developing and updating contract templates, contract policies and procedures.
  • Supports and assists in the development of the annual budget; assists in developing contracting goals, strategies, activity plans and projections.
  • Department liaison with the Credentialing department and keeper of updated clinic and practitioner rosters, W-9s, licensures and other pertinent documents that may be needed to initiate contracting discussions.
  • Assist Contracting with pay or requests, provider/clinic rosters, practitioner/clinic forms, etc.
  • Completes payer directory reviews to monitor program provider on-line payer directory accuracy. Work directly with payers to update and optimize when appropriate.
  • Develops collaborative relationships with BayMark Office staff and health plan contacts (and other payer representatives)
  • Internal network liaison for other departments (i.e., Credentialing, RCM, Contract Management, Business Development, Finance, Compliance and Operations.)
  • Facilitates meetings with contracted managed care plans when requested and develops individual relationships with key payer counterparts.
  • Collaborates cross functionally to evaluate emerging departmental risks and ensure alignment on risk mitigation.
  • Assists with other projects or initiatives that support improvements with business developments and new payers, i.e., Value Based Payment Programs, ER program initiatives, G code implementation support.
  • Other duties and projects as assigned by department Sr. Vice President.
  • Demonstrated strong business acumen, data analytic skills, management/supervisory skills, and experience with project management and customer relationship management.
  • Demonstrated leadership skills, relationship development, team building and communication skills.
  • Ability to work independently, manage multiple projects simultaneously with a high sense of urgency and budget effectively without close supervision.
  • Must be a self-starter, creative, proactive and organized with strong interpersonal and communication skills with a collaborative work style.
  • Excellent written, proofreading and verbal communication skills.
  • Proficient computer skills in MS Office Suite, with the willingness to learn new programs as required
  • Comply with BayMark policies and procedures, Compliance Policy and Code of Ethics.
  • Manages database of payer agreements and reimbursement rates for various treatment lines of business, OTP/OBOT/Detox/RTC such as Commercial, Managed Medicaid, and Medicare Advantage agreements and Value Based Agreements.
  • Tracks, monitors and communicates to Contractors when payer contracts are near term to target for renewal re-negotiations and assists with data collection and preparation for Value Based Agreement reporting.
  • Maintains logs and tracking systems to assure new contracts and amendment updates make it through the approval and signature process in a timely manner after negotiations.
  • Assists Provider Relations contracting and data analyst team with research prior to negotiations including analysis of historic utilization patterns and resource consumption; payment history; identification of administrative issues; and prioritizing opportunities for improvement.Minimum Qualifications
    • Bachelor's Degree Preferred
    • Minimum of 5 years payer relations, contracting, and/or credentialing experience in a pay or provider setting including experience with financial/contract terms and development of contract language.
    • Working knowledge of leading-edge managed care methodologies and practices and managed care contract language and interpretation.
    • Experience working in an environment of acquisitions and growth, along with change management preferred.
    • Supports, encourages, and contributes to the professional growth of all department staff.
    • Effective communication, organization, and interpersonal skills essential.
    • Excellent oral and written communication skills.
    • Computer savvy with thorough knowledge of Microsoft Office (Word, Excel, Outlook, PowerPoint).
    • Collaborates with internal and external stakeholders and has strong interpersonal skills.
    • Excellent organizational and time management skills.
    • Critical attention to detail, deadlines, and reporting.
    • Ability to function effectively in a remote work and office-based environment.
    • Compliance with accepted professional standards and practices.
    • Satisfactory references from employers and/or professional peers
    • Satisfactory criminal background check
    • Satisfactory drug screenBenefits:
      • Competitive salary
      • Comprehensive benefits package including medical, dental, vision and 401(K)
      • Generous paid time off accrual
      • Excellent growth and development opportunities
      • Satisfying and rewarding work striving to overcome the opioid epidemicCOVID-19 considerations:Everyone will be asked to be in compliance with the most recent COVID guidelines from CDC, State, County and City. Here is what you can expect from us:BayMark Health Services, a progressive substance abuse treatment organization, is committed to the highest quality of patient care in a comfortable outpatient clinic setting.Our ultimate goal is to address the physical, emotional, and mental aspects of opioid use disorder to help each of our patients achieve long-term recovery and an improved quality of life.BayMark Health Services is committed to Equal Employment Opportunity (EEO) and to compliance with all Federal, State and local laws that prohibit employment discrimination on the basis of race, color, age, natural origin, ethnicity, religion, gender, pregnancy, marital status, sexual orientation, citizenship, genetic disposition, disability or veterans status or any other classification protected by State/Federal laws.EA22PI196930929

Keywords: BayMark Health Services, Lewisville , Payer Relations Manager, Executive , Lewisville, Texas

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