Payer Contracts Specialist - Dme/Healthcare

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The Contract Administrator will provide oversight, management, coordination, organization and communication of payor contracting activities for each of the ABC Medical family of companies. The Contract Administrator will be responsible for maintaining all company payer agreements, addendums, renewal terms, and required notification or due dates. The position supports the entire payer contract process and collaborates with the sales team and internal departments to ensure staff are informed of new contracts and, changes to existing contracts. Key factors include supporting the sales growth by developing new contracts with payers and expanding contract coverage with existing payers where there is expanded network opportunity.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

Include the following as well as other duties and responsibilities, which may be assigned:

• Develop, negotiate and maintain contracts with all payers, e.g., insurance companies, IPAs, TPAs and government programs.
• Administer payer contracting process for each of the legal entities and locations within the organization.
• Review new and update existing contracts. Receives, files and disseminates information provided by payers to responsible parties.
• Responsible for the accuracy of supporting documentation for contracts and completing documents accurately.
• Facilitate the approval process of all contract documents from pre-contract through post-contract signature phases.
• Works with legal, credentialing and all relevant involved teams to ensure contracts are compliance.
• Monitor all contract deadlines and conditions to ensure timelines are kept and all relevant information has been met.
• Provides contract summaries and ensure contract execution in accordance with company policy. Supports providing a monthly report to senior management and organizational stakeholders with progress and status of contracted payor agreements.
• Supports the maintenance of a common provider directory/database for enrollment with payers.
• Supports the research of territories to identify gaps in our payer base to support contract expansion.
• Assist with all contracting administration and projects, as needed.

QUALIFICATIONS:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily and must possess the ability to: interact professionally and ethically with the company’s business partners, and payors; handle multiple tasks simultaneously; provide clear, concise oral and written directives/communications; quickly assess situations and respond appropriately; handle special requests in a sensitive, professional manner. Strong attention to detail and follows through is required. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

QUALIFICATION REQUIREMENTS:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

EDUCATION AND/OR EXPERIENCE:

Associate or bachelor’s degree, or relevant 2 years contract healthcare experience

• Strong demonstrated knowledge and understanding of healthcare industry, legal and regulatory requirements.
• Ability to understand, and articulate complex financial and contractual issues
• Strong analytical and organizational skills required
• Solid verbal and written communication skills
• Able to multitask, prioritize, and manage time efficiently
• Keen attention to detail, with ability to spot errors
• Results driven, persistent - able to self-direct and work independently showing initiative, while seeking guidance when appropriate.
• Proficient computer skills, Microsoft Office Suite (Word, PowerPoint, Outlook, and Excel)
• Ability to work with varying seniority levels including staff, managers and external partners
• Experience working at a medical insurance company, IPA, TPA highly preferred
• Familiarity and experience with DME and/or Medical Supply reimbursement, including Medicare, Medicare Managed, Medicaid, and Medicaid Managed plans.
• Knowledge and use of Brightree software preferred but not required.

TRAINING:

Our industry is a highly regulated industry, and because of that and our commitment to providing the best in class products, services, and support, we require ALL employees to complete the following training programs prior to the marketing and promotion of our products, services, and support systems:

• Anti-Kick Back Training
• Fraud, Abuse, and Waste Training
• HIPPA Training
• Systems Training