PAYER RELATIONS SPECIALIST, UWMEDICINE - CONTRACTING & PAYER RELATIONS

UWMEDICINE CONTRACTING & PAYER RELATIONS has an outstanding opportunity for a PAYER RELATIONS SPECIALIST.
WORK SCHEDULE

Full-Time - 100% FTE

POSITION HIGHLIGHTS

Responsible for the support of the Payer Relations Program's contract negotiation efforts as well as maintenance and management of the contracting process

Shared service across UWMed with system wide impact

Interact with a variety of stakeholders and customers (internal and external)

DESCRIPTION
The PAYER RELATIONS SPECIALIST provides support in the efforts of the Payer Relations Program of the UW Medicine's Contracting & Payer Relations Department in the managed care/health insurance contracting process, including assistance in negotiations of large and small scale managed care agreements, assistance in drafting and review of contract language, maintenance of online and physical contract files, research of payer policies and healthcare regulations and laws, assistance in resolution of contract-related issues, completion of annual facility/payer credentialing applications, and other contracting-related tasks as applicable.
PRIMARY JOB RESPONSIBILITIES

Conduct research, communications, and analysis to appropriately respond to or evaluate issues raised by Contracting staff or internal/external stakeholders and develop/facilitate responses

Assist in oversight of contract document control process to assure that contract documents are executed and filed in an accurate, consistent, and efficient manner, and filed/maintained in compliance with all applicable laws, regulations, and UW Medicine policies

Complete annual payer credentialing applications and forms for facilities, including communication with payers and internal stakeholders as necessary

Ensure that annual facility credentialing (including re-credentialing) applications and forms are accurately submitted within the timelines required by contracted managed payers

Maintain accurate and consistent records of submitted credentialing applications and forms, payer responses and communications related to applications and forms, and all other relevant documents

Assist in negotiations with contracted managed care payers to secure favorable contract terms, including reimbursement rates, key contract language, and issue resolution

Assist in protests and/or appeals of adverse hospital and/or professional services claims decisions by payers, including research of relevant case facts, contracts, payer policies, or regulations, drafting of protest/appeal letters, and communications with UW Medicine and payer staff

Organize, oversee, attend, and/or participate in periodic payer operations meetings in collaboration with the Director of Provider Relations

Track issues and resolutions to issues to possibly address in subsequent contract negotiation processes

Communicate with contracted payer and UW Medicine staff members as is required to accomplish the day to day duties and functions of the Contracting & Payer Relations Department

Negotiate and draft single case contracts with government and commercial managed care payers to to accurately reflect all relevant agreement details, including but not limited to reimbursement terms, payment deadlines, and risk mitigation terms

Maintain information and data related to single case contracts and provide regular reporting regarding single case contract volumes, related charges and reimbursement, and other key information

Draft and review managed care contract language as is required to accomplish day to day duties and functions of the Contracting & Payer Relations Department

REQUIRED QUALIFICATIONS

Bachelor's Degree in Business, Health Administration, Nursing or other related fields

A minimum of two to three years experience in care/health insurance contracting and negotiations, healthcare provider reimbursement, health insurance payer/provider relations, and/or healthcare payer policies/processes

Equivalent experience may substitute for the degree requirement

ABOUT UW MEDICINE - A HIGHER DEGREE OF HEALTHCARE
UW Medicine is Washington's only health system that includes a top-rated medical school and an internationally recognized research center. UW Medicine's mission is to improve the health of the public by advancing medical knowledge, providing outstanding primary and specialty care to the people of the region, and preparing tomorrow's physicians, scientists and other health professionals.
All across UW Medicine, our employees collaborate to perform the highest quality work with integrity and compassion and to create a respectful, welcoming environment where every patient, family, student and colleague is valued and honored. Nearly 29,000 healthcare professionals, researchers, and educators work in the UW Medicine family of organizations that includes: Harborview Medical Center, UW Medical Center - Montlake, UW Medical Center - Northwest, Valley Medical Center, UW Medicine Primary Care, UW Physicians, UW School of Medicine, and Airlift Northwest.
Become part of our team. Join our mission to make life healthier for everyone in our community.
Committed to attracting and retaining a diverse staff, the University of Washington will honor your experiences, perspectives and unique identity. Together, our community strives to create and maintain working and learning environments that are inclusive, equitable and welcoming.
The University of Washington is an affirmative action and equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, gender expression, national origin, age, protected veteran or disabled status, or genetic information.
To request disability accommodation in the application process, contact the Disability Services Office at 206-543-6450 or dso@uw.edu.
Applicants considered for this position will be required to disclose if they are the subject of any substantiated findings or current investigations related to sexual misconduct at their current employment and past employment. Disclosure is required under Washington state law.