Manager of Payer Contract & Revenue Optimization

Position Goal

Manages existing and new payer contracts and fee schedules to ensure accurate reimbursement across our payers and Hughston entities. Manages Appeals Analysts to achieve organizational metrics on appeals, denials and recoveries.

Position Responsibilities:

• Manage healthcare network participation, and negotiate and maintain competitive contracts with assigned healthcare insurance payers
• Works closely with all data owners to ensure claims and reimbursement data transfers are loaded to Contract Management system and Credentialing system in a timely and accurate manner
• Ensure contractual language is kept current; evaluate fee schedule on a yearly basis to identify possible opportunities for additional covered services, strategic partnerships, medical policy changes and reimbursement updates
• Facilitate training for new and existing staff members on Contract Management system tools
• Analyze Contract Management system reports to identify variances in claims payment data
• Ensures appeal staff work effectively and optimizes work flows
• Facilitate the review and approval process of all contract documents from pre-contract through post signature phases, accuracy of supporting documentation, and timely maintenance in systems
• Develop and maintain processes that provide timely notification and administration of critical contract events (e.g., annual rate updates, contract renewals, termination and other critical contract requirements)
• Assist with all contracting administration and projects, as needed
• Analyze claims data reports to identify trends, issues and recovery opportunities
• Conduct data modeling in support of payer negotiations
• Creates and implements policies and procedures to promote effective appeals and recoveries processes

Experience:
Required:

• Five (5) years of relevant experience within the healthcare field

Preferred:

•  Claims and reimbursement analysis and various reimbursement methodologies
• Appeals and denial recovery processes
• Leading and motivating a team
• System implementation experience is a plus 

Education:
Required:

• Bachelor’s degree in health/business administration or related field or
• High School Diploma with five (5) years relevant experience

Special Qualifications:
Required:

• Excellent contract negotiation skills.
• Demonstrated knowledge and understanding of healthcare industry.
•  Willingness to actively participate in all aspects of the contract management process.
• Results driven, persistent – able to self-direct and work independently showing initiative, while seeking guidance when appropriate.
• Demonstrated strength in various computer software including, MS Office Suite, PowerPoint, as well as proficiency in utilizing social media platforms and internet-based research.
• Demonstrated effective written, verbal, and electronic communication that is professional in both content and delivery.
• Ability to work as a team member, take initiative, exercise independent judgment, decision-making, and problem-solving expertise.
• Must have a valid driver’s license and a satisfactory Motor Vehicle Record (MVR)

The Hughston Clinic, The Hughston Foundation, The Hughston Surgical Center, Hughston Clinic Orthopaedics, Hughston Medical, Hughston Orthopaedics Trauma, Hughston Orthopaedics Southeast and Jack Hughston Memorial Hospital participate in E-Verify. This company is an equal opportunity employer that recruits and hires qualified candidates without regard to race, religion, color, sex, sexual orientation, gender identity, age, national origin, ancestry, citizenship, disability, or veteran status.