Payor Relations Administrator - Managed Care

EDUCATION & EXPERIENCE:

Minimum Qualifications:

• Bachelor’s degree in a related field (e.g. Healthcare Administration, Business Administration, Public Health, or a relevant discipline) required.
• A minimum of 3 years of proven experience in payor relations, revenue cycle management in a hospital setting, or a related field with the healthcare industry.
• Strong understanding of healthcare reimbursement methodologies, regulations, and compliance requirements.

JOB SUMMARY:

This The Payor Relations Administrator is responsible for developing, managing, and maintaining positive relationships with payors on behalf of the organization. Independently tracks and follows up on outstanding issues with both internal and external stakeholders. Stays updated with industry trends, regulatory changes, and reimbursement policies to ensure compliance and maximize reimbursement for the organization.

ESSENTIAL JOB FUNCTIONS:

• Serves as the primary point of contact for payors and maintains strong working relationships.
• Identifies opportunities to increase recovery of outstanding Accounts Receivable by working closely with Revenue Cycle Operations.
• Responsible for recovery of a minimum of $5,000,000 of old account receivable accounts per fiscal year.
• Analyzes reimbursement trends, denials, and payment discrepancies to identify areas of improvement to maximize reimbursement.
• Understands payors’ policies, procedures, and requirements to facilitate effective collaboration.
• Assists in the coordination of both Joint Operating Committee Meetings and Outstanding Claims Meetings with the payors.
• Coordinates Weekly meetings with Revenue Cycle Operations Leadership as well as specific outstanding accounts receivable meetings with RCO.
• Addresses payor inquiries and complaints, resolves issues, and escalates complex matters as needed internally.
• Identifies opportunities for internal process improvements and coordinates training and educational opportunities with the payors

Marginal or Periodic Functions:

• Adheres to internal controls and reporting structure.
• Performs related duties as required

WORKING ENVIRONMENT/EQUIPMENT:

Standard office environment.