E00425 – Payor Relations Specialist
Department Overview: This Department is responsible for provider enrollment and contracting across multiple states. Additionally, this department supports multiple internal stakeholders including Revenue Cycle Management, Utilization Review, and Compliance functions as it relates to maintaining adherence to contractual obligations.
Specific Job Responsibilities:
- Gather, review, and submit credentialing applications, as required, for network development and management, including both commercial and governmental payors.
- Maintain tracking system so all department team members are aware of credentialing application status at all times.
- Complete periodic re-credentialing applications as required by each payor.
- Maintain current provider manuals for all payors and share with other departments as appropriate.
- Analyze payor bulletins and distribute key information to the relevant internal stakeholders.
- Prepares and submits provider demographic data changes, prepares rosters, maintains current directories for all payors.
- Provide general support to all network development activities and support other Managed Care team members with implementation requirements.
- Collaborates with other departments to address and resolve operational issues as related to negotiated contracts.
- Perform duties to act as a liaison between providers, payors, and the company including investigating and resolving provider claims issues.
- Receive and respond to internal and external provider related issues.
- Responsible for remaining educated on payor/provider policy changes by attending payor education webinars, townhalls, etc.
- Demonstrate excellent customer service.
- Work on special projects as needed and assist co-workers in completion of critical tasks.
Education and Experience:
- Bachelor’s Degree Preferred
- Minimum of 2 years of credentialing experience required
- Knowledge of contract platforms required (i.e. facility contract, group contract, etc.)
- Ability to multi-task and manage multiple competing priorities
- Demonstrate ability to work in a fast-paced environment
Work Environment: This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, and filing cabinets. The noise level in the work environment is usually moderate.
Physical Demands: While performing the duties of this position, the employee is regularly required to talk or hear. The employee frequently is required to use hands to finger, handle or feel objects, tools or controls. The employee is occasionally required to stand; walk; sit; reach with hands and arms; climb or balance; and stoop, kneel, crouch or crawl. The employee must occasionally lift and/or move objects up to 25 pounds. Specific vision abilities required by this position include close vision, distance vision, color vision, peripheral vision and the ability to adjust focus.
Travel: Travel is primarily local during the business day, although some out-of-the-area and overnight travel may be expected.