Manager, Payer Relations - Managed Care

Oceans Healthcare•Plano, TX

21d

About The Position

The Manager, Payer Relations reports to the Vice President of Strategic Payer Relations and Performance and oversees the full life cycle of managed care contracts. This role manages contract organization and compliance, supports negotiations, develops reporting and performance tools, coordinates payer credentialing, and facilitates communication and education across the organization. The Manager also participates in payer committees, dispute resolution, and process improvement initiatives to strengthen Oceans payer relationships and revenue cycle performance.

Responsibilities

Organizes, monitors, and maintains all managed care payer contracts in a transparent, centralized data base that is reportable and accessible across the enterprise.
Works collaboratively with key internal and external stakeholders to coordinate communication of contract terms and provisions.
Completes education and training to various internal parties, including hospital administrative and clinical staff, regarding new or updated contract requirements.
Under the strategic direction of the Vice President of Strategic Payer Relations and Performance, participates in the contract negotiation process to finalize and execute new agreements and to improve contractual language and reimbursement terms in existing agreements.
Facilities single case agreements for VP approval.
Develops payer scorecards and/or other reporting mechanisms to monitor overall payer performance.
For value-based contracts, articulates Oceans' provider scorecard results to hospital and executive leadership.
Participates in process improvement to enhance potential VB contract incentives.
Responsible for coordinating and completing payer credentialing for new hospitals and services and recredentialing or existing locations and services.
Coordinates and participates in monthly, quarterly and annual payer operating committee meetings to ensure timely and accurate resolution of contract related items.
Assists in payer dispute resolution projects, settlements, etc.
Performs other duties and projects as assigned.