Remote Contract Manager Payor Relations-Must reside in Ohio

Contract Manager Payor Relations

The Payor Contract Manager at Nationwide Children’s Hospital is responsible for payor contracting activities including:  negotiating assigned managed care contracts with third party payors; monitoring payment accuracy and key contractual terms of assigned payor contracts; implementing assigned payor contracts throughout the NCH system; developing communication vehicles and educational tools designed to educate and assist staff in meeting contractual requirements; and serving as a liaison between the health plans and key departments throughout NCH (e.g., case management, patient financial services, medical staff, etc.).

Schedule: (Full time, Remote in Ohio, Benefits Eligible)

Location:

Remote [Candidates must reside in Ohio]

Responsibilities

• Establish and maintain relationships with managed care plans and third party payors. Utilizing all available resources to prepare and maintain demographic, statistical and biographical payor profiles. Serves as the “information expert” on all payors.
• Negotiates, manages, and maintains documentation for payor/managed care contracts with third party payors for Nationwide Children’s Hospital and its affiliated subsidiaries (e.g., Nationwide Children’s Homecare Services and physician groups).
• Implement payor/managed care contracts throughout the organization. Actively engages payor and NCH staff to validate key implementation terms.
• Manage and report on payor contract adherence, e.g. administrative and payment.
• Coordinate payor/managed care contracting efforts with internal clinical resource management activities.
• Identify, document and resolve adverse and inappropriate payor trends relative to expectations.
• Serves as primary informational and resolution contact for NCH constituents.
• Provide ongoing reporting, analysis, and trouble-shooting support for the Payor Relations Department.
• Responsible for ensuring external contract rate loading and internal verification of contract rates.
• Lead and contribute to other projects and initiatives as directed by Director of Payor Relations

KNOWLEDGE, SKILLS AND ABILITIES REQUIRED:

Education:

• Minimum requirement of Bachelor’s degree in business or related field with Master’s degree in health services and/or business administration preferred;

Required Experience:

• Proven leadership track-record, along with 3-5 years of previous management experience in leading and coordinating efforts of staff;
• At least 5-7 years of experience in negotiating facility, physician, home health, behavioral health and other provider types preferred
• Proven ability to facilitate teamwork with physicians and clinical leadership;
• Excellent communication, organizational, writing, and analytical skills;
• Working knowledge of hospital and physician coding and billing;
• Interest in excelling and in assuming progressively more responsibility in dynamic health care environment.

Minimum Physical Requirement:

• Sitting   (Constantly)
• Talking on phone or in person  (Frequently )   
• Typing on a keyboard (Frequently  )
• Standing/walking  (Occasionally )

EOE/M/F/Disability/Vet.