Payer Operations Manager

Children's Healthcare Of Atlanta Chamblee , GA 30341

Posted 2 months ago

Location: Park North

  • Harvard

Requisition #: 44628


Tracks, manages, and communicates the status of assigned third party payer issues and operational initiatives. Facilitates designated meetings with payers toward actionable outcomes. Collaborates with the Director, Managed Care Operations to identify strategic solutions and coordinate proactive follow-up and reactive issue management with appropriate representatives from both external and internal stakeholders.


  • Bachelor's Degree in Business or health-related discipline; or equivalent experience in lieu of degree


  • No professional certifications required


  • 3 years of experience working at a payer or provider in a relevant role involving provider/payer relationships

  • Experience with revenue cycle operations


  • N/A


  • Well-developed organizational, communication and interpersonal skills

  • Must be able to work with confidential information

  • Advanced PC skills

  • Excellent analytical and problem-solving skills

  • Ability to research and analyze concepts and details

  • Ability to document and succinctly present research findings

  • Ability to explain, present or discuss difficult information and gain group consensus

  • Ability to work within deadlines and resource constraints

  • Ability to interact effectively with managers, staff and outside stakeholders

  • Ability to function effectively as a part of a team


1.Facilitates and manages assigned third-party payer operations meetings, monthly claims calls, or ad-hoc meetings in coordination with Revenue Cycle and CPG to ensure operational issues are being addressed in an efficient manner.

2.With the Director, Managed Care Operations, develops and implements strategies to administer Children's contracts with third-party payers, whilst preserving Children's contractual rights.

3.Builds and maintains strong collaborative relationships with both third party payers and internal stakeholders. Communicates identified payer operational issues to both internal and external parties, acting as mediator and troubleshooter in disputes with third party payers.

4.Develops, tracks and maintains project plans and strategies for assigned third party payers. Identifies possible solutions to overcome roadblocks/barriers to internal stakeholders and leadership. Serves as a resource for internal stakeholders to troubleshoot complex authorization, claim or denial issues.

5.In coordination with Managed Care Contracting, Revenue Cycle, Utilization Review, CPG, Performance Analytics, and Service Lines, ensures all issues are being addressed, updated and communicated.

6.Reviews third party payer correspondence or communication for potential issues that would impact both operational and clinical processes. In coordination with Performance Analytics and Finance Project Management, provides detail for Children's mitigation strategy. Communicates regular notifications to multiple departments informing them of changes in third party policies and requirements.

7.Assists Director, Managed Care Operations, Director, Managed Care Contracting and Vice President, Managed Care to complete strategic and business plans as required by Children's.

8.Performs other activities related to Children's managed care activities, as requested.

9.Supports and participates in the continuous assessment and improvement of the quality of care and services provided.


Safety: Practices proper safety techniques in accordance with hospital and departmental policies and procedures. Responsible for the reporting of employee/patient/visitor injuries or accidents, or other safety issues to the supervisor and in the occurrence notification system.

Compliance: Monitors and ensures compliance with all regulatory requirements, organizational standards, and policies and procedures related to area of responsibility. Identifies potential risk areas within area of responsibility and supports problem resolution process. Maintains records of compliance activities and reports compliance activities to the Compliance Office.


Ability to lift up to 15 lbs independently not to exceed 50 lbs without assistance


  • Frequently (activity or condition exists from 1/3 to 2/3 of time)


  • Occasionally (activity or condition exists up to 1/3 of time)


  • Effective communication with employees, supervisors/managers and staff. Effective communications with patients and visitors, as required.


  • Occasionally (activity or condition exists up to 1/3 of time)


  • Occasionally (activity or condition exists up to 1/3 of time)


  • Frequently (activity or condition exists from 1/3 to 2/3 of time)


  • Occasionally (activity or condition exists up to 1/3 of time)


  • Occasionally (activity or condition exists up to 1/3 of time)


No potential for exposure to blood and body fluids

About Us:

Children's Healthcare of Atlanta has been 100 percent committed to kids for more than 100 years. A not-for-profit organization, Children's is dedicated to making kids better today and healthier tomorrow.

With 3 hospitals, 27 neighborhood locations and a total of 638 beds, Children's is the largest healthcare provider for children in Georgia and one of the largest pediatric clinical care providers in the country. Children's offers access to more than 70 pediatric specialties and programs and is ranked among the top children's hospitals in the country by U.S. News & World Report.

Children's has been ranked on Fortune magazine's list of "100 Best Companies to Work For" for fourteen consecutive years and named one of the "100 Best Companies" by Working Mother magazine. We offer a comprehensive compensation and benefit package that supports our mission, vision and values. We are proud to offer an array of programs and services to our employees that have distinguished us as a best place to work in the country. Connect to our mission of making kids better today and healthier tomorrow.

Have questions about the recruitment process? Check out What to Expect.

Address: 3375 Northeast Expressway, Atlanta, GA 30341

Function: Finance/Accounting

  • Managed Care

Nearest Major Market: Atlanta

Job Segment: Manager, Pediatric, Project Manager, Management, Healthcare, Technology

icon no score

See how you match
to the job

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Lease Up Property Manager

Alliance Residential Company

Posted 1 week ago

VIEW JOBS 3/29/2020 12:00:00 AM 2020-06-27T00:00 Opportunity Starts Here: Since opening in 2000, the culture at Alliance has been one with an entrepreneurial spirit that consistently pushes the evolution of the multifamily industry. As a result, we've revolutionized the apartment living experience and continue to be recognized for delivering world-class services and exceptional customer experiences. And that's really why we are here in the first place - to build homes, lifestyles, and opportunities for those who call Alliance home. It's this mission that propels us forward each day, motivating us to craft work environments that are engaging, empowering, and dedicated to professional advancement. If you're looking for a fast-pace, ever-evolving career that rewards grit and perseverance, you've come to the right place. Welcome home. A Day in the Life: As our Business Manager you will ensure all aspects of your luxury property are performing at optimum levels to achieve the highest Net Operating Incomes possible. You will be responsible for the management of all on-site operations, financial performance, team development, customer satisfaction, and retention. What You'll Do: * Oversee and manage all aspects of assigned asset * Manage leasing activities to ensure budget goals are achieved on a consistent basis * Interview and select qualified associates for positions by working closely with Regional Leadership and Talent Advisors * Provide guidance, mentorship, support, and coaching (including associate separations) when necessary by managing, motivating, and supervising on-site team * Oversee all Alliance systems and proper usage to maintain accurate and timely data * Thoroughly understand, follow and promote the Alliance Five Star Program * Educate and assist team to excel on all Key Performance Indicators (KPI's) and standards set for performance * Motivate team to stay in compliance with all training in Fuse; Monitor and assist in scheduling for completion and achieve 100% compliance * Produce weekly, monthly, and quarterly reports on property performance * Analyze, scrutinize budget, and outline all financial information produced * Monitor survey result through the Kingsley portal regularly to identify issues and create a plan of action for a result driven solution What You'll Need to Succeed: Required: * High school diploma or equivalent. Preferred: * Bachelor or Associates degree * Minimum of 2 years' previous experience in the multi-family, sales, retail, hospitality, property management or industry related field * Previous lease-up/new construction experience * Prior customer facing experience * Prior experience managing people * Industry certifications(s) (ARM, CAM, CPM, NALP, etc. Other Knowledge, Skills, and Abilities: * Ability to motivate and empower staff/team to achieve daily, weekly, and monthly property goals. * Provide leadership and guidance to the team; hold team accountable for performance results by being an example of leadership and professionalism * Strong intermediate mathematical abilities and experience reading community financials * Software skills in Word, Outlook, and Excel, and a variety of industry specific platforms and systems * Excellent verbal and written communication skills * Excellent customer service skills * Attention to detail and follow-up skills What You'll Receive: * Professional and upbeat work environment * Competitive compensation and incentives * Paid training and professional development opportunities * Generous paid time off including vacation, sick, holiday, birthday and volunteer time * Low Premiums for Medical, dental and vision coverage; including access to telemedicine * Paid parental leave for eligible new parents * Flexible spending account * Health saving account with Company match * 401k program with Company match * Housing discounts (When available) * Flexible hours and remote positions (when available) * Company-paid life insurance * Short and long term disability coverage * Team building events * Associate wellness program, including financial wellness (partnerships with Gradifi and Bank of America) * Regional and National Award programs * Associate referral bonus program Alliance Residential Company Chamblee GA

Payer Operations Manager

Children's Healthcare Of Atlanta