What are the responsibilities and job description for the Payer Contracting Specialist position at Specialty Dental Brands?
Description
The Payer Contracting Specialist at Specialty Dental Brands is responsible for the coordination of all Network insurance contract details. Provides assistance, as required, for all contract-related using necessary and appropriate financial data to ensure sound contracting decisions. Assists in the review of insurance contracting language to ensure ongoing compliance to contract terms by both Network and Payer.
Qualifications
The Payer Contracting Specialist at Specialty Dental Brands is responsible for the coordination of all Network insurance contract details. Provides assistance, as required, for all contract-related using necessary and appropriate financial data to ensure sound contracting decisions. Assists in the review of insurance contracting language to ensure ongoing compliance to contract terms by both Network and Payer.
Qualifications
- Responsible for coordinating all contract-related details utilizing appropriate tools to ensure compliance with contract terms.
- Develops timely and accurate calendars of key contract dates that require communication/interaction with insurance companies.
- Assists in the detailed review of contract language to ensure the contract can be administered, limit legal exposure, and ensure appropriate defined criteria in terms of the business office, case management, charge master/UCR, coding, etc.
- Assists in the implementation and administration of payer contracts within the parameters established by the Manager, Payer Contracting, and the Vice President of Revenue Cycle.
- Maintain payer specific problem/issues list for all insurance companies under contract
- Supports the revenue cycle and clinical areas of the hospital by researching payer-specific issues and, as necessary, contacting the payer for problem resolution.
- Coordinate and participate in regular meetings with Payer-Provider Representatives to discuss/resolve issues.
- Supports analysts by researching payer contract questions and discrepancies to ensure
- Ongoing review of the contract management document database to ensure accuracy and completeness.
- Responsible for the dissemination of payer communications to appropriate departments related to payer restrictive policies, contract changes/terminations/additions, etc.
- Assist the Manager, in the production and analysis of payer-specific data from the Contract Management system to identify payment trends and issues.
- Stays abreast of governmental payment legislation and evaluates contractual arrangements for applicability/opportunity (i.e. Medicare/Medicaid managed care plans).
- Assist the Manager in developing and maintaining a strong professional relationship with the payer community. Meets on a regular basis with the payer team and involves appropriate internal staff as necessary.
- Five (5) years of revenue cycle experience
- Bachelor’s Degree or Equivalent Experience
- Extensive understanding of payer rules and denial management
- Three (3) to five (5) years of Dental, Hospital, ASC, or physician practice business office and/or health care contract administration experience including identifying and maintaining compliance with contract terms
- Strong quantitative, and analytical skills and well-versed in contract implementation
- Knowledgeable regarding analytical tools and techniques, including report writers, spreadsheets, database software, and graphical presentation software.
