Payor Relation Specialist

Payor Relation Specialist

Job Category: Sales & Marketing

Location: Altivera Corporate Office 8181 E Tufts Ave Denver, CO 80237, USA

Description

What You'll Work On

• Review correspondence, provider manuals, and provider policies as needed
• Support accuracy of payor performance scorecard metrics
• Manage credentialing requests, including initial & ongoing credentialing
• Coordinate payor meetings
• Develop, maintain, and present to leadership the KPIs/metrics related to areas of responsibility
• Representing the payor relations function as a core team member on cross-functional projects

Competencies & Skills Needed:

• Adaptability & Innovation - Exhibits flexibility in adapting to changing priorities and departmental shifts, quickly implements feedback, and applies creative problem solving to overcome barriers and drive continuous process
• Collaboration & Communication - Communicates professionally and clearly, actively listens, and provides accurate support to relevant teams while fostering a cooperative work environment; shares feedback, clarifies barriers effectively, and approaches situations with a "one team, one goal" mindset
• Quality & Accuracy - Upholds the department standard by producing work consistently with attention to detail, minimal errors, and thorough verification to ensure tasks are completed correctly and efficiently.
• Quantity & Productivity - Effectively manages time and resources to meet deadlines/demands and maintain department and individual goals. Consistently meets KPI expectations as set by the department. Takes initiative to be autonomous in daily responsibilities.
• Reliability - Consistently demonstrates punctuality for work and meetings, minimizes disruptions to operations, and proactively communicates any schedule changes
• Technical Proficiency & Knowledge - Demonstrates a deep understanding of the processes, software, and resources required for the role, effectively applying technical skills to complete daily tasks while following department work instructions and adhering to Altivera Medical's standards

Essential Job Duties & Responsibilities:

• Building trusting and professional relationships with third-party payors.
• Support the initiation, management and expansion of contracted relationships with payors at desired reimbursement rates and payment terms.
• Support a quarterly strategic and tactical plan focused on gaining contracts with targeted payers for the company's services.
• Coordinate the prioritization of payor relationships to ensure they fit with, support, and compliment the customer base and the current efforts and focus of the organization
• Explore and target multiple payor types, including MCOs (Managed Care Organizations) such as HMOs (Health Maintenance Organizations), PPOs (Preferred Provider Organizations), IPAs (Individual Practice Associations), self-insured employers, unions, etc.
• Understand and support building relationships with key influencers with new healthcare models (ACO's, IHN's, PCMH's) and/or large employer groups.
• Support educating our Sales and Marketing Teams, along with various other departments on the current healthcare payor landscape
• Collaborate with Sales pre-contract to help succeed in getting contracts and post-contract to ensure maximization of the contract while driving utilization of contracted payors.
• Correspond with payor representatives, and others via phone call and email in a professional manner.
• Provide requested information to Insurance carriers and other payors.
• Be responsible for maintaining accurate records and providing detailed, professional notes in payor files.
• Supporting the procurement of payor contracts when beneficial for Altivera.
• Able to speak to and educate payors of Altivera Medical's mission, vision, and products.
• Monitoring and identifying market trends.
• Other duties as assigned
• A strong customer-focused mindset.
• Meet goals outlined by department leadership.
• Complete other duties, as assigned by Management

Minimum Job Qualifications:

• Genuine interest in helping people.
• Ability to speaks confidently and accurately during negotiation and sales conversations
• Exceptional investigative thinking skills to determine reasons a payor may take adverse action and use critical thinking skills to determine appropriate next steps.
• Ability to perform with a high degree of independent judgment, discretion, and confidentiality; and make complex decisions within a short amount of time.
• Exceptional communication (written & verbal) skills and Excellent organizational skills.
• Superior phone communication skills.
• A minimum of 3 years' experience in a healthcare-oriented position.
• Knowledge of healthcare insurance industry
• Grasp of key metrics, performance measures, and technical indicators.
• Aptitude for analysis and strategy.
• Excellent interpersonal and customer relations skills.
• Negotiation and conflict resolution skills.
• Dynamic and creative problem-solving abilities.
• Detail-oriented when working in a fast-paced environment.
• Ability to occasionally travel as needed

Preferred:

• Strong knowledge of the health insurance industry (specifically payor relations) and an established network within the healthcare payor space.
• 3+ years' experience working with CMS (Medicare/Medicaid) and/or The Joint Commission

Education Requirements:

• Bachelor's Degree or equivalent experience. A college degree is desired.

Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.