Payor Contract Specialist

Cleveland Clinic

1d•Hybrid

About The Position

At Cleveland Clinic Health System, we believe in a better future for healthcare. And each of us is responsible for honoring our commitment to excellence, pushing the boundaries and transforming the patient experience, every day. We all have the power to help, heal and change lives — beginning with our own. That’s the power of the Cleveland Clinic Health System team, and The Power of Every One. As a Payer Contract Specialist, you will be responsible for collecting and analyzing managed care contract information to support effective contract implementation, compliance monitoring, operational efficiency, and customer service initiatives. You will disseminate contract details to provider organizations, facilities, and operational departments, ensuring alignment and understanding across all stakeholders. In addition, you will research and recommend solutions to issues related to claim payments, reimbursement, and operational processes. This role plays a key part in facilitating the resolution of outstanding claims to optimize revenue and promote patient satisfaction. A caregiver in this position works remotely from 8:00 a.m. -- 4:30 p.m., with flexible start times available as early as 7:00 a.m. or as late as 9:00 a.m. One day per quarter is required to be worked onsite.

Requirements

Bachelor's Degree in Business, Marketing, Healthcare or a related field OR High School Diploma/GED and three years of related experience
Strong desktop computer skills (Word, Excel, Access, PowerPoint, Outlook)
Ability to relate effectively to physicians and hospital administration and to handle service issues and complaints in a professional and diplomatic manner

Nice To Haves

One year of managed care or provider relations experience
Experience with payers and claims
Experience presenting and running meetings
Excel experience

Responsibilities

Collect and assimilate managed care contract information to support contract implementation, compliance monitoring, operations and customer service functions.
Act as an internal resource to community hospitals, institutes and other internal departments.
Provide contract-specific information and resolution of issues to payors and internal customers.
Research, track and manage issues related to claim payment, reimbursement, operations and general information requests.
Manage and track escalated, high-profile and highly complex issues, making recommendations to resolve them.
Negotiate case-specific agreements with local, regional, national and international payors for tertiary referrals, as well as agreements for other services and Cleveland Clinic facilities.
Gather, research and distribute contract-related information for compilation, communication and implementation.
Prepare communications, summary sheets, quick reference guides and implementation checklists for assigned payor contracts.
Contribute materials for the Managed Care newsletter and websites.
Coordinate informational sessions for payor contract implementation and education.
Arrange and facilitate meetings with payor representatives for contract maintenance or problem resolution.