Payer Relations Manager

　　Job LocationsUS

　　Overview Position Summary:

　　Reporting to the Director of Payer Relations this position manages current contracts for assigned portfolio, new contracts, contract renewals and negotiations including assessment of historical performance and issues, identification of payer specific issues as well as opportunities and recommendations which incorporate strategic and critical thinking approaches resulting in desired outcomes. The Payer Relations Manager is responsible for managing payer contract lifecycle for his/her assigned portfolio and continually identifies and evaluates new opportunities. The manager establishes, fosters, and maintains positive relationships with payers to optimize contract terms and negotiate favorable rates. This role requires a deep understanding of audiology group and hearing aid benefit reimbursement methodologies, the ability to analyze and synthesize large data sets, and a commitment to maintaining the highest level of data integrity. Acts as an internal consultant and will work collaboratively with many cross-functional teams within HearingLife.

　　Purpose Statement:

　　To help more people hear better by ensuring the best experience for Team Members and meets the highest standards of patient services while achieving financial growth for HearingLife clinics in a manner consistent with HearingLife's Core Values.

　　Responsibilities Essential Job Functions:

　　- Obtains and catalogs fully executed current payer contracts into Payer Relations data repository along with up-to-date fee schedules, and payer contact information.

　　- Manages the lifecycle of all contracts in the assigned portfolio ensuring terms and fee schedules are optimally aligned with business objectives.

　　- Monitors new contract leads and existing contract renegotiations processes confirming fully executed contracts are received and cataloged with fee schedule and payer contact information.

　　- Responds to assigned market requests by performing independent research, collecting data, and analyzing data to respond to field inquiries. Collaborates on responses under the guidance of the Director Payer Relations.

　　- Research assigned geographical areas to identify new opportunities with payers, self-insured employers, and partnerships. Initiates contact with targeted organizations to obtain potential agreements. Summarizes agreement and models' potential revenue to determine value of contract.

　　- Monitors, quantifies, and facilitates resolution of payer issues identified by the Revenue Cycle Team. Collaborates on developing and implementing an action plan for payment resolution by leveraging contacts at the payer.

　　- Develops, maintains, and continuously fosters relationships with payers, unions, associations, medical groups, and self-funded employers. Manages the communication outreach, value propositions, and documents efforts in the contract management system as appropriate.

　　- Replies to payer compliance attestation requests, quality, and reporting requirements by providing clinical outcomes or data required by payors.

　　- Partners with the Revenue Cycle Team to develop an intake and approval process for single case agreements or one-time negotiations. Ensures approved agreements are communicated timely to the providers.

　　- Responsible for tracking, redlining, and analyzing new contracts, amendments, and rate proposals.

　　- Establishes trust and credibility by fostering a positive relationship with Senior Executives, People Leaders, and Departments supporting revenue cycle.

　　- Stays apprised of legislative efforts related to insured and uninsured patients, educating others, and recommending organizational changes to programs as a result.

　　- Acts as subject matter expert for Learning and Development to create training modules and tools as part of operationalizing new contractual agreements. Communicates plan specific payer requirements to all stakeholders.

　　- Remains current with trends, regulatory requirements, and business strategies related to the payer relations and revenue cycle.

　　- Operates in compliance with all local, state, and Federal laws as well as HearingLife policy and compliance standards.

　　- Maintains knowledge of current computer systems (i.e., POS, DM, AX, etc.).

　　This job description is not intended be an inclusive list of responsibilities. Duties, responsibilities, and activities may change, or new ones may be assigned at any time with or without notice.

　　QualificationsEducation and Experience:

　　- Bachelor's degree in Business, Finance, Healthcare Management, or Information Technology required.

　　- Master's degree preferred.

　　- 5+ years-experience in payer contracting and negotiations.

　　- Knowledge of ICD, CPT, and HCPCS coding systems.

　　- Expertise in network development processes, contract language, principles of negotiation and credentialing.

　　- Ability to analyze and interpret contracts, key performance metrics and performance reports.

　　- High attention to detail with ability to analyze and summarize data.

　　- Ability to work independently and as part of a team with all levels of leadership.

　　- Strong critical thinking skills and the ability to manage and prioritize multiple projects required.

　　- Advanced Microsoft Office skills - Excel, Power Point, Word, and Visio.

　　- Strong computer skills relevant to the position required. Considerable experience using Excel, PowerPoint and Word required.

　　- Proven ability to drive performance, metric outcomes and collaborate cross-departmentally to help meet and exceed organizational goals.

　　- Initiative-taker who excels in a fast paced, data driven, complex work environment.

　　- Knowledge of and ability to articulate explanations of Medicare, Medicaid, HIPAA, EMTALA, No-Surprise Act as well as other government assistance programs and regulations. Some of our Benefits:- Unwind with Paid Time Off: We value work-life balance. Enjoy company-paid holidays, floating holidays, and more!

　　- Flexible Work Dynamics: Experience the future of work with numerous hybrid and remote opportunities tailored for the modern professional.

　　- Comprehensive Health Benefits: Choose from a diverse range of health insurance plans covering medical, dental, vision, and HSA. Your well-being is our priority.

　　- Invest in Your Future: With our competitive 401(k) Program, your future looks bright.

　　- Exclusive Discounts & Programs: Get special discounts on our products, including hearing aids, for both family and possibly friends. Plus, take advantage of our Employee and Family Purchase Hearing Aid program.

　　- Boundless Growth Opportunities:

　　- DMIT Program: Dive deep into management insights.

　　- Apprentice Program: Learn from the best in the field.

　　- Amplify Leadership Program: Get one-on-one guidance and real-world exposure to grow and excel as a Leader.

　　- A Thriving, Positive Environment: We live our Core Values: We Create Trust, We are Team Players, We Apply a Can-Do Attitude and We Create Innovative S

　　- Empower Your Ambitions: Avail up to $5250 annually with our Education Expense Reimbursement. Keep learning, keep growing!

　　- Refer & Earn: Know someone perfect for the team? Our Team Member Referral Program rewards you with up to $3500 per hire, depending on the role.

　　- Protection for the Unexpected: Enjoy peace of mind with our basic life and AD&D insurance, as well as short-term disability insurance.Come be part of a team where every day brings new challenges, learning, and the opportunity to make a difference. Join us!

　　We are an Equal Opportunity / Affirmative Action employer, all qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, sex, national origin, disability, or protected veteran status.#hearinglife_US

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