Utilization Review Specialist

Payer Relations SpecialistUWMEDICINE CONTRACTING & PAYER RELATIONS has an outstanding opportunity for a PAYER RELATIONS SPECIALIST.Work ScheduleFull-Time - 100% FTEHybrid SchedulePosition HighlightsSupport payer relations operations through research, analysis, and coordination of managed care contracting activities.Assist with drafting, reviewing, and maintaining contract documents and credentialing applications to ensure accuracy and compliance.Contribute to negotiations, issue resolution, appeals, and single-case contract development through policy research, document preparation, and stakeholder communication.DescriptionThe PAYER RELATIONS SPECIALIST provides support in the efforts of the Payer Relations Program of the UW Medicine's Contracting & Payer Relations Department in the managed care/health insurance contracting process, including assistance in negotiations of large and small scale managed care agreements, assistance in drafting and review of contract language, maintenance of online and physical contract files, research of payer policies and healthcare regulations and laws, assistance in resolution of contract-related issues, completion of annual facility/payer credentialing applications, and other contracting-related tasks as applicable.Primary Job ResponsibilitiesConduct research, communications, and analysis to appropriately respond to or evaluate issues raised by Contracting staff or internal/external stakeholders and develop/facilitate responsesAssist in oversight of contract document control process to assure that contract documents are executed and filed in an accurate, consistent, and efficient manner, and filed/maintained in compliance with all applicable laws, regulations, and UW Medicine policiesComplete annual payer credentialing applications and forms for facilities, including communication with payers and internal stakeholders as necessaryEnsure that annual facility credentialing (including re-credentialing) applications and forms are accurately submitted within the timelines required by contracted managed payersMaintain accurate and consistent records of submitted credentialing applications and forms, payer responses and communications related to applications and forms, and all other relevant documentsAssist in negotiations with contracted managed care payers to secure favorable contract terms, including reimbursement rates, key contract language, and issue resolutionAssist in protests and/or appeals of adverse hospital and/or professional services claims decisions by payers, including research of relevant case facts, contracts, payer policies, or regulations, drafting of protest/appeal letters, and communications with UW Medicine and payer staffOrganize, oversee, attend, and/or participate in periodic payer operations meetings in collaboration with the Director of Provider RelationsTrack issues and resolutions to issues to possibly address in subsequent contract negotiation processesCommunicate with contracted payer and UW Medicine staff members as is required to accomplish the day to day duties and functions of the Contracting & Payer Relations DepartmentNegotiate and draft single case contracts with government and commercial managed care payers to accurately reflect all relevant agreement details, including but not limited to reimbursement terms, payment deadlines, and risk mitigation termsMaintain information and data related to single case contracts and provide regular reporting regarding single case contract volumes, related charges and reimbursement, and other key informationDraft and review managed care contract language as is required to accomplish day to day duties and functions of the Contracting & Payer Relations DepartmentRequired QualificationsBachelor's Degree in Business, Health Administration, Nursing or other related fieldsA minimum of two to three years experience in care/health insurance contracting and negotiations, healthcare provider reimbursement, health insurance payer/provider relations, and/or healthcare payer policies/processesEquivalent education and/or experience may substitute for minimum qualifications except when there are legal requirements, such as a license, certification, and/or registration.Compensation, Benefits and Position DetailsPay Range Minimum: $69,720.00 annualPay Range Maximum: $90,000.00 annualOther Compensation: -Benefits: For information about benefits for this position, visit First Shift (United States of America)Temporary or Regular?: This is a regular positionFTE (Full-Time Equivalent): 100.00%Union/Bargaining Unit: Not ApplicableAbout the UWWorking at the University of Washington provides a unique opportunity to change lives – on our campuses, in our state and around the world.UW employees bring their boundless energy, creative problem-solving skills and dedication to building stronger minds and a healthier world. In return, they enjoy outstanding benefits, opportunities for professional growth and the chance to work in an environment known for its diversity, intellectual excitement, artistic pursuits and natural beauty.Our CommitmentThe University of Washington is committed to fostering an inclusive, respectful and welcoming community for all. As an equal opportunity employer, the University considers applicants for employment without regard to race, color, creed, religion, national origin, citizenship, sex, pregnancy, age, marital status, sexual orientation, gender identity or expression, genetic information, disability, or veteran status consistent with UW Executive Order No. 81.To request disability accommodation in the application process, contact the Disability Services Office at View phone number on click.appcast.io or View email address on click.appcast.io considered for this position will be required to disclose if they are the subject of any substantiated findings or current investigations related to sexual misconduct at their current employment and past employment. Disclosure is required under Washington state law.