Healthcare Payer Relations & Contracting Specialist

Job Description

The Healthcare Payer Relations & Contracting Specialist holds a pivotal role in fostering positive relationships with healthcare payers and managing effective contracts to ensure fair and timely reimbursement for our hospice company's compassionate end-of-life care services. This multifaceted position requires adept communication, negotiation skills, and collaboration with payers, as well as a commitment to advocating for reimbursement terms that align with our mission and uphold the financial stability of the organization. Must be able to work on-site at the Corporate Miramar, Florida office, Monday through Friday 8am- 5pm. Hybrid schedule.

All duties and responsibilities are to be performed in accordance with VITAS Healthcare Corporation's policies, procedures, guidelines, contractual commitments, and governmental regulations.

1. Contract Management:

• Draft, review, and negotiate contracts with healthcare payers, hospice service providers, and other partners.

• Ensure that contracts align with the organization's strategic goals and comply with all legal and regulatory requirements.

2. Contract Review:

• Conduct detailed reviews of contract terms, payment rates, and performance metrics to identify areas for negotiation and improvement.

• Collaborate with the Payer Relations & Contracting Manager and legal counsel to address contract-related issues.

3. Payer Relations:

• Assist in maintaining positive relationships with healthcare payers and partners.

• Work with the Payer Relations team to advocate for favorable reimbursement rates and terms.

4. Compliance and Documentation:

• Ensure that all contracts and agreements are accurately documented and stored in accordance with company policies.

• Monitor compliance with contractual obligations, regulations, and accreditation standards.


5. Cross-Functional Collaboration:

• Collaborate with various departments, including Payer Relations, Revenue Cycle, Finance, Operations, and Legal, to support the organization's financial and operational goals.

6. Performance Metrics:

• Track and report on contract performance, including revenue and reimbursement data.

• Work with Payer Relations Specialist to provide regular updates to management on the status of contracts and payer relationships.

• Stay informed about changes in the healthcare industry, payer policies, and regulations affecting hospice care.

7. Payer Relationship Management:

• Cultivate and maintain strong working relationships with healthcare payers, including insurance companies, government programs (Medicare and Medicaid), hospice associations, and other third-party payers.

• Serve as the primary point of contact for both internal and external partners at the health plans, state, and hospice associations.

8. Communication and Collaboration:

• Facilitate regular communication with payers to address inquiries, resolve issues, and negotiate favorable terms.

• Collaborate with internal departments, including Contracting, Credentialing, Revenue Cycle, Operations, Finance and Quality Assurance, to support effective payer relations.

• Assist PR&C Manager collaborations with state and hospice association.


9. Contract Advocacy:

• Work with the Contract Specialist to advocate for favorable contract terms and reimbursement rates during contract negotiation processes.

• Monitor the impact of contract terms on reimbursement and report findings to the Payer Relations & Contracting Manager.

10. Claims and Reimbursement:

• Monitor and track the status of claims escalations, ensuring timely and accurate reimbursement from payers.

• Collaborate with the PR&C Manager and Revenue Cycle team to address payment discrepancies or denials and identify trends.

• Assist the PR&C Manager with the preparation of reports on payer performance and trends for internal stakeholders.


• Provide insights and recommendations for process improvements in payer relations and reimbursement optimization.

11. Compliance and Regulatory Adherence:

• Ensure that all interactions with payers comply with regulatory requirements and industry standards.

• Stay informed and report back changes in payer/state policies, regulations, and reimbursement models to ensure compliance.

12. Continuous Improvement:

• Proactively identify opportunities to enhance the department's efficiency and effectiveness to report back to the PR&C Manager

• Recommend and implement process improvements to enhance contract management and negotiation processes.

QUALIFICATIONS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.

Experience:

• Minimum of 3 years of experience in contract management, preferably in a healthcare or hospice setting.

• Strong understanding of healthcare payer systems, reimbursement models, and insurance policies.

• Excellent negotiation and communication skills.

• Exceptional relationship-building skills.

• Detail-oriented with strong analytical abilities.

• Ability to analyze data and make data-driven decisions.

• Knowledge of healthcare regulations and compliance standards.

• Proficiency in contract management software and Microsoft Office Suite.

• Ability to work both independently and as part of a team.

• Strong problem-solving skills and the ability to adapt to changing industry dynamics.

Education:

Bachelor's degree in business, healthcare administration, or a related field preferred.

Certification & Licensure:

None required for this position.


Physical Requirements:

Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions of the job.

About Us

VITAS® Healthcare is the nation's leading provider of end-of-life care, and has the resources and expertise to support your personal and professional growth. As a member of the VITAS team, you'll find fulfillment working for a people-focused organization dedicated to making a difference in the lives of others. You will be more than just an employee: You will be counted on as an expert in your field, and as a valued team member whose efforts are respected and vital to our hospice mission.

All VITAS employees commit to fulfilling their duties and responsibilities with the highest regard for professionalism, collaboration and teamwork, and an eye focused constantly on growth and improvement. We serve with commitment and compassion, and position ourselves for the future by embracing, innovating, and leading change. If you are that person, make your voice heard-find your purpose at VITAS today.


Benefits Include:


- Competitive compensation
- Health, dental, vision, life and disability insurance
- Pre-tax healthcare and dependent care flexible spending accounts
- Life insurance
- 401(k) plan with numerous investment options and generous company match
- Cancer and/or critical illness benefit
- Tuition Reimbursement
- Paid Time Off
- Employee Assistance Program
- Legal Insurance
- Roadside Assistance
- Affinity Program


Many of our positions offer the opportunity to work day or night shifts, weekdays or weekends.


Choose a Career with VITAS