Advisor, Managed Care, Payer Relations

What Managed Care contributes to Cardinal Health Managed Care oversees the business and administrative operations of a medical practice. Managed Care oversees the interactions that take place between payer and provider(s) to ensure optimal reimbursement including managed care contracting, enrollment, credentialing, and any other activity as it relates to payer interaction. Payer Relations Manager is responsible for the oversight and administration of third-party payor contracts, exercising independent judgment and discretion in supporting contract negotiations, implementation, and ongoing compliance. This role manages the contract lifecycle, including single case agreements, contract documentation, fee schedule oversight, and the integrity of contract data within management systems. The Payer Relations Manager evaluates contract administration accuracy, identifies and leads corrective actions, monitors payor policy and reimbursement changes, and ensures timely communication of contract terms and requirements to internal stakeholders. Acting as a subject matter resource, the role supports operational teams, coordinates payor implementation activities, and contributes to organizational financial and operational objectives through effective payor relationship management. Responsibilities Assist with negotiating contracts with payors as directed Negotiate single case agreements with non-contracted plans, Medicaid, Medicaid HMO plan and international Manage contract management and maintenance ensuring systems are updated when contract terms change. Communicate all details regarding contracts to the internal/external team. Monitor the Managed Care email inbox ensuring proper action is taken. Assists educating team(s) regarding new contract implementations, changes to existing contracts, cancelled contracts, payer requirements, new programs required by payers, etc. Identify and lead the correction on any inaccurate administration of the contracts. Assist in coordinating/monitoring third party payor implementation activities including acting as a resource for internal operations Insure all new or renegotiated contracts or amendments and any supporting documents are updated on all resources in a timely basis Oversee fee schedule loading and calculations Assess the quality of the contract information entered into the contract management system Maintain contract matrices outlining contract terms for third party payors Provide business units with the tools necessary to effectively administer new contract terms and rates, changes in third party payor policies Monitor and communicate payor changes to appropriate stakeholders. Performs any other functions as required by management. Qualifications At least five (5) years of experience in a managed care contracting, working directly with managed care/third party contracts preferred Specific knowledge of the payer environment and payer issues, particularly billing and collections preferred Ability to work a flexible schedule (including overtime, and weekends), as necessary. Analytical and computational skills Excellent customer service and communication skills. Ability to work independently and as part of a team. Working experience with Excel spreadsheets and Microsoft Word documents. What is expected of you and others at this level Applies comprehensive knowledge and a thorough understanding of concepts, principles, and technical capabilities to perform varied tasks and projects May contribute to the development of policies and procedures Works on complex projects of large scope Develops technical solutions to a wide range of difficult problems Solutions are innovative and consistent with organization objectives Completes work; independently receives general guidance on new projects Work reviewed for purpose of meeting objectives May act as a mentor to less experienced colleagues Anticipated salary range: $ 80,900.00 -$92,400.00 Bonus eligible: No Benefits Cardinal Health offers a wide variety of benefits and programs to support health and well-being. Medical, dental and vision coverage Paid time off plan Health savings account (HSA) 401k savings plan Access to wages before pay day with myFlexPay Flexible spending accounts (FSAs) Short- and long-term disability coverage Work-Life resources Paid parental leave Healthy lifestyle programs The salary range listed is an estimate. Pay at Cardinal Health is determined by multiple factors including, but not limited to, a candidate’s geographical location, relevant education, experience and skills and an evaluation of internal pay equity. Candidates who are back-to-work, people with disabilities, without a college degree, and Veterans are encouraged to apply. Cardinal Health supports an inclusive workplace that values diversity of thought, experience and background. We celebrate the power of our differences to create better solutions for our customers by ensuring employees can be their authentic selves each day. Cardinal Health is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, ancestry, age, physical or mental disability, sex, sexual orientation, gender identity/expression, pregnancy, veteran status, marital status, creed, status with regard to public assistance, genetic status or any other status protected by federal, state or local law. #J-18808-Ljbffr Cardinal Health