Payor Relations Specialist

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A Brief Overview

At the Childrens Hospital of Philadelphia Practice Association (CHOPPA) we believe in making a meaningful impacttogether. Were looking for a collaborative and detail-oriented Payor Relations Specialist to join our dedicated Reimbursement Strategy and Contracting team.

In this role youll help ensure that our health systems payor contracts are fully understood and followed working to strengthen revenue streams and reduce administrative roadblocks. Your efforts will directly support CHOPs goal of helping our teams focus on what matters most: delivering exceptional care to children and families.

Youll work closely with leaders across departments and divisions to identify and address managed care challenges stepping in when issues need to be escalated with payors. If youre passionate about problem-solving relationship-building and contributing to a purpose-driven team wed love to meet you.

This hybrid role requires on-site attendance one day a week (Tuesday or Thursday) during regular MondayFriday day shift hours with additional in-office presence for special meetings as needed.

What you will do

• The Payor Relations Specialist supports the enterprise by being the source of information related to payor contracts payor policies and guidelines new plan information (market intel) and other relevant information related to the payor market.

• Serves as the primary point of contact with payors for contractual rate changes for the PFS-P to the Manager of Revenue Analytics.

• Provides contract interpretation support and education for the health system.

• Prospectively identifies operational and financial opportunities for the health system specific to a new payor agreement.

• Organizes and leads contract implementation process with completion of new agreements and contract terminations.

• In partnership with the Reimbursement Strategy and Contracting leaders is an active participant in analyzing new and renewal contracts with the payor

• Works closely with Access and Revenue Cycle teams to identify and remove or reduce access and revenue cycle barriers.

• Tracks and prepares business perspectives of contracts for Legal review. Supports other contract negotiations as required.

• Provides monthly updates of payor policies and procedures within the health system.

• Interacts with all individuals in the organization in a professional and customer-focused manner.

Required Education Qualifications

• Bachelors Degree

Required Experience Qualifications

• At least seven (7) years industry and topical related experience

Skills and Abilities

• Must possess strong understanding of the local managed care environment including but not limited to managed care policies and procedures payment models and managed care models.
• Ability to interpret complex and comprehensive managed care information.
• Excellent communication skills (including oral and written presentation) demonstrated organizational skills ability to multi-task.
• Strong interpersonal skills.
• Ability to work independently achieves specific goals and objectives and provides recommendations for improvement.
• Ability to work collaboratively with a strong orientation for bottom line results.
• Strong working knowledge of key computer applications such as EPIC and Microsoft Office suite of products.
• Ability to work with large set of diverse data with the ability to summarize in to meaningful presentable and actionable information

To carry out its mission CHOP is committed to supporting the health of our patients families workforce and global community. As a condition of employment CHOP employees who work in patient care buildings or who have patient facing responsibilities must receive an annual influenza vaccine. Learn more.

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SALARY RANGE:

At CHOP we are committed to fair and transparent pay practices. Factors such as skills and experience could result in an offer above the salary range noted in this job posting. Click here for more information regarding CHOPs Compensation and Benefits.