Health Insurance Contracting & Payer Relations Admin I

YOUwere meant for Hopkins.

What Awaits You

• Career growth and development
• Diverse and collaborative working environment
• Generous Paid Time Off
• Tuition Reimbursement
• Affordable and comprehensive benefits package

This is a remote role- applicants working from MD DC VA PA DE or FL will be given first consideration.

Job Summary

Ensures compliance with the administration negotiation implementation surveillance and oversight of Single Case Agreements (SCAs) for contracted and non-contracted payors. Serves as a resource for staff at all JHM Operational Units Senior Management levels as well as front line staff regarding SCA processes managed care contracts and payer reimbursement guidelines. Provides operational guidance and coordination related to SCA negotiations payer relations contract compliance and reimbursement activities to support effective and complaint managed care operations. Provides oversight surveillance and maintenance of Managed Care SCA reference materials and SCA-related information posted on the Managed Care website to ensure accuracy accessibility and compliance with organizational and payer requirements.

Job Functions

• Negotiates and manages individual patient Single Case Agreements (SCAs) and payer contract activities for contracted and non-contracted payors.
• Assists with the identification and coordination of non-contracted patient cases requiring SCA review and operational follow-up.
• Coordinates the implementation execution maintenance and compliance of SCAs and payer contract documentation.
• Develops and maintains collaborative relationships with payer representatives and internal stakeholders.
• Provides operational guidance and serves as a resource regarding managed care reimbursement and SCA workflows.
• Develops and delivers education training and resource materials related to SCAs payer operations and managed care processes.
• Monitors payer contract and SCA performance reimbursement activity operational effectiveness and regulatory developments.
• Supports process improvement and operational implementation initiatives related to payer relations and managed care activities.
• Prepares reports analyses and summaries related to SCA activity and payer relations.
• Acts as operational resource to departments regarding payer and reimbursement issues.

Qualifications

• Bachelors Degree in business administration or healthcare administration or a related field (Required)
• One year of relevant education may be substituted for one year of required work experience or one year of relevant professional-level work experience may be substituted for one year of required education.
• Experience in payer relations or contract management (Required)
• Navigate rapidly changing situations from evolving patient needs to technological advancements by remaining flexible continuously learning embracing new challenges and quickly recovering from setbacks.
• Good written and verbal communication skills with an emphasis on confidentiality tact and diplomacy.
• Strong attention to detail and self-directed to consistently ensure data integrity and accuracy.

Salary Range: Minimum 31.53/hour - Maximum 52.06/hour. Compensation will be commensurate with equity and experience for roles of similar scope and responsibility. In cases where the range is displayed as a $0 amount salary discussions will occur during candidate screening calls before any subsequent compensation discussion is held between the candidate and any hiring authority.

The Hospital reserves the right to modify employee schedules as needed.

We are committed to creating a welcoming and inclusive environment where we embrace and celebrate our differences where all employees feel valued contribute to our mission of serving the community and engage in equitable healthcare delivery and workforce practices.

Johns Hopkins Health System and its affiliates are an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race color religion sex sexual orientation gender identity and expression age national origin mental or physical disability genetic information veteran status or any other status protected by federal state or local law.

Johns Hopkins Health System and its affiliates are drug-free workplace employers.