Payer Contracting Negotiator

Sound Physicians

Brentwood, TN, US
  • Job Type: Full-Time
  • Function: Accounting/Finance
  • Post Date: 06/06/2021
  • Website: soundphysicians.com
  • Company Address: 1498 Pacific Avenue, Suite 400, Tacoma, WA, 98402

About Sound Physicians

Sound Physicians is a leading healthcare organization with a proven track record of improving quality, satisfaction and financial performance for its hospital partners nationwide.

Job Description

Under the supervision of the Vice President, Payer Contracting, the Payer Contracting Negotiator is responsible for all duties related to managing payer contracts, negotiations and renegotiations of new and existing payer contracts. This position works closely with members of the Payer Contracting, Payer Strategies, Provider Enrollment and the Revenue Management team to ensure all contracts are appropriately identified, modeled, negotiated, implemented, audited and renegotiated timely and pursuant to budgeted targets.

 

Essential Duties and Responsibilities

  • Responsible for the development, coordination and analysis of multiple types of physician contracts
  • Negotiates reimbursement and language of physician contracts, specifically hospital based providers (Hospitalists, intensivists, emergency room physicians, anesthesiologists, etc.)
  • Reviews contract terms and conditions in order to facilitate accurate implementation of contracts
  • Responsible for identifying managed care opportunities in the marketplace
  • Establishes productive personal relationships with Payer reps
  • Resolve escalated contract specific issues of Payers
  • Manage special projects as required
  • Works closely with Payer Contracting Operations & Provider enrollment teams to ensure timely notification of changes to Payers
  • Manages the planning process for contract renewals and negotiations including assessment of historical performance and issues as well as identification of payer specific issues
  • Identify opportunities and recommendations for specific Payers
  • Assist with analysis of Payer Mix & Proforma info and utilization
  • Proactively identify, research, understand and present issues that impact Sound Physicians and partner facilities to Vice President, Payer Contracting and other senior leaders as needed
  • Working knowledge of MS Excel and MS Excel logic for reporting and projects as needed
  • Mentor Payer Contracting Liaisons in all aspects of payer contracting activities
  • Other duties as assigned

 

 

Special Knowledge, Skills, Abilities, Training or Special Licenses/Certifications needed to perform this Job

  • Able to handle multiple tasks simultaneously, meet time sensitive deadlines and organize workload with limited supervision
  • Must have a working knowledge of current policies and guidelines that affect contracts,

pricing, rebates etc. in the managed care environment

  • Working knowledge of  Payer Enrollment structure and processes
  • Current working knowledge of Medicare reimbursement methodologies, fee schedule development, utilizing financial models and analysis in negotiating rates with Payers.
  • Analytic knowledge of provider reimbursement nationally and trends affecting reimbursement regionally around the country
  • Excellent organization abilities as well as written and oral communication skills
  • Creative and persistent problem solver
  • Attention to detail and accuracy
  • Client/service oriented (internal and external)
  • Maintain strict confidentiality of sensitive information
  • Ability to interact and communicate with individuals at all levels of organization
  • Ability work in a group setting
  • Ability to complete projects independently within established timeframes
  • Proficiency with Microsoft Office Suite
  • Proficient typing skills

 

Education

  • Bachelor’s degree with 5+ years Managed Care, Payer and/or Physician/Hospital contracting experience with or for regional/national payers
  • Advanced analytics background including contract modeling and/or knowledge of value based contracting methodologies
  • Preferred – 10+ years Managed Care Payer or Physician/Hospital contract negotiations experience including analytics/modeling/value based contracting with or for regional or national payers
  • Preferred- experience with hospital based providers, specifically Anesthesia
  • Required - Advanced understanding/knowledge of computer data entry, SharePoint,

Microsoft Excel and ability to navigate through any business related software

 

List Special Job or Environmental Conditions

  • Indoor office environment
  • Some travel required

 

Other Physical and/or Special Requirements about this job:

  • Sitting at a desk up to eight hours (with breaks)
  • Working on computer for up to eight hours (with breaks

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Disclaimer: Local Candidates Only
This company does NOT accept candidates from outside recruiting firms. Agency contacts are not welcome.