Payor Relations Specialist

Northside Hospital is award-winning, state-of-the-art, and continually growing. Constantly expanding the quality and reach of our care to our patients and communities creates even more opportunity for the best healthcare professionals in Atlanta and beyond. Discover all the possibilities of a career at Northside today.
Provides broad support to the managed care team and is familiar with a wide variety of concepts, practices and procedures necessary to meet the goals of the department. The Payor Relations Specialist will work closely with each contract manager and will support the various aspects of a complex negotiation. The Payor Relations Specialist will be particularly focused on the management of network status of our professional and ancillary service lines.
PRIMARY DUTIES AND RESPONSIBILITIES
* Maintain positive relationships with key payor contacts that can influence par status with our providers, especially the professional and ancillary providers.
* Independently research, analyze and resolve claim issues with timely follow up and professional communication.
* Supports negotiations with payors through analysis, research, and communication.
* Independently support the department's communications with credentialing, billing, practice management, business office, and other departments as necessary.
* The Payor Relations Specialist will be an expert in resolving issues with our managed care partners.
* Manages miscellaneous ad hoc research and cost analysis projects in support of the Managed Care Department negotiations.
* The Payor Relations Specialist will work directly and independently with Payors to monitor progress on Joint Operating Committee meetings.
REQUIRED:
* Bachelor's degree or equivalent experience of no less than four years provider relations and/or provider contracting experience.
* Strong understanding of hospital reimbursement methodologies .
* Strong understanding of activities, practices, tools and considerations for managing the claims adjustment process.
* Experience with contract modeling software.
* Ability to work independently.
* Strong analytical skills.
* Excellent organizational skills.
* Excellent communication skills.
* Strong working knowledge of computer spreadsheet programs and database programs such as Access.
PREFERRED:
* McKesson/HBOC Trendstar CPA
* Microsoft Excel and Access

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