Job Description

Position Summary

The Payer Relations Specialist works primarily with the Contracts and Payer Relations Manager supporting the contracting process, and ensuring up to date, accurate information is present for payer configuration. The Payer Relations Specialist is primarily internally facing, but may interact with external parties as needed to maintain rates, sites, and service implementation and updates in various system.

Essential Job Functions:

• Logging and tracking all contracts, contract amendments, and agreements submitted to the organization to ensure timely and accurate review, and approval(s).
• Maintaining accurate records and files of contracts, agreements and amendments and supporting documentation.
• Monitor provider update emails and contracts mailbox for updates and requests for information and/or action.
• Maintain internal location site/service database and entry of updates/changes as needed.
• Ensure accurate directory information internally and with payers.
• Supports contract related rate and system set up requirements in electronic health record in conjunction with revenue cycle team to ensure timely and accurate billing.
• Conduct quality assurance duties related to rate, site and service configuration in electronic health record and/or payer system(s).
• Complete and submit site addition/change forms to Payers.
• Assist in maintenance of current information on site identifiers and program credentials; including managing and updating any changes within EHR system.
• Work with Contracts and Payer Relations Manager regarding payer and our internal Claims department to resolve contract related denials or billing issues.
• Interact with internal team(s) regarding updates state (NC Tracks; NPPES; Alpha CMS and Provider Direct, Payers e.g.) and internal systems to reflect agency changes as needed, including terminations.
• Assists in EHR and other internal system assessments for the department to identify opportunities that maximize system efficiencies, and assists in the development of strategies for meeting those needs.

Minimum Qualifications

• Associate’s Degree from USDOE or CHEA accredited institution or accredited High School Diploma with 3 year’s work experience in behavioral healthcare, contracting or provider relations.
• 1 to 3 years’ experience working with Medicaid, Medicare, Private Insurance and Managed Care Organization (MCO) IPRS Billing or;
• 1-3 years’ experience working in NC Tracks
• 1-3 years’ experience working in Alpha CMS and/or Provider Direct.
• Ability to effectively communicate, both verbally and written.
• Self-starter with a positive, outgoing personality and attitude.
• Strong knowledge of Microsoft Office Word, Excel, and Outlook.
• Excellent organizational skills and attention to detail.
• Ability to multi-task and work well under pressure.
• Ability and desire to be a team player.
• Ability to work independently.
• Must possess a state-appropriate, unrestricted driver’s license and personal vehicle insurance.
• Experience with legal documents and contracting preferred.

Equipment Used:

Telephone, Fax, Internet, Copier, Calculator, Electronic Health Record, IBM compatible personal computers with related finance and word processing software, and Microsoft Office software products.

Essential physical requirements:

• Must possess the visual acuity to develop written correspondence and determine accuracy, neatness and thoroughness of the work assigned.
• Must be able to physically perform the basic life operational functions of talking, hearing, sitting for long periods of time and performing repetitive motions, such as using a computer.
• Must be able to speak audibly, write legibly and perform repetitive motions such as data entry.

Environment:

Must be able to work in a shared office environment, while displaying respect and professionalism toward others in the office. Some travel required, which may include exposure to inclement weather and overnight stays.