Responsible as the primary operations contact at EvergreenHealth for maintaining relationships with contracted payers and health plans. Responsible for the maintenance of managed care plan operating policies and systems and fostering effective relationships with payers and providers related to those managed care plans. Responsible for communication and dissemination of appropriate contract and payer information throughout the EvergreenHealth system and accountable for thorough analysis and the development of appropriate solutions to issues and projects.
Responsible as primary lead for organization in communications to payers for policy clarifications, issue resolution, updates, etc.
Along with Payer Contracting Manager, responsible for addressing internal inquiries regarding payer payment rates and fee schedules.
Works closely with the Revenue Cycle team (Admitting, Medical Records, Business Office, Revenue Integrity etc.) to ensure that the organization's complex health plan contracts meet the constantly changing reality of EH's operations and resolves any corresponding issues.
Maintains relationship and compliance with contracted payers, assuring EvergreenHealth facilities and providers meet obligations to health plan/subcontracted party and vice versa.
Serves as information conduit to key staff and constituents - EvergreenHealth Medical Group, Patient Access, Patient Financial Services, Care Management, Home Health, Hospice, and EvergreenHealth Partners; includes the maintenance of SharePoint as an internal information source.
Facilitates timely compliance with health plan credentialing requirements and completes various applications for centers of excellence on behalf of EvergreenHealth
Responsible for auditing payer directories of providers and works to ensure accuracy of that information
Responsible for file and documentation maintenance
Helps schedule and coordinate meetings, i.e. payer inservices, education, etc.
Performs other duties as assigned.
License, Certification, Education or Experience:
REQUIRED for the position:
Bachelor's degree or equivalent amount of work experience
3 years of experience with health insurance payment methodologies and managed care concepts
Experience with provider/hospital operations and/or health insurance
Experience with patient financial accounting and data analysis
Ability to problem solve effectively and creatively
Ability to be proactive, self-directing and take initiative
Facilitation, conflict resolution, problem-solving, persuasion and analytical skills
Ability to work collaboratively with managed care, decision support and other financial analysts and guide necessary data analysis.
Ability to manage multiple projects concurrently with multi-disciplinary teams.
DESIRED for the position:
2 years of formal project management or leadership experience
Experience with Microsoft Office Suite
This position is open for internal candidates only.