Position Goal

The Payor Contract Manager provides support in and manages existing and new payor contracts and relationships. The Payor Contract Manager supports the company all while providing support across the Managed Care department to maintain existing healthcare insurance payor partnerships.

Position Responsibilities:

• Manage professional service healthcare network participation and negotiate and maintain competitive contracts with all targeted healthcare insurance payors. This includes researching territories to maintain a balanced payor mix, addressing gaps with our payor base and supporting expansion into new markets.
• Maintain proactive relationships with payors and develop new relationships as required to support Hughston’s strategic objectives. Ensure contractual language is kept current; evaluate fee schedule on a yearly basis to identify possible opportunities for additional covered services, strategic partnerships, medical policy changes and reimbursement updates.
• Facilitate the review and approval process of all contract documents from pre-contract through post signature phases, accuracy of supporting documentation, and timely maintenance in systems.
• Develop and maintain processes that provide timely notification and administration of critical contract events (e.g., any annual rate updates, contract renewals, termination, proper notices, and other critical contract requirements).
• Establish influential relationships with practice administrators and billing department to ensure staff is informed of contractual requirements and any changes in medical policy & billing policies.
• Conduct on-going assessments of payor mix, contract performance, regulatory changes and make recommendations for annual forecasts, strategic initiatives, goals, and objectives.
• Support the due diligence process, as required, for add-on practice expansion.
• Develop and maintain periodic reports on the status of all contracts.
• Assist with all contracting administration and projects, as needed.

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Experience:

Required:

• Five years of relevant experience with healthcare payor, clinic, or physician.

Education:

Required:

• Bachelor’s degree in health/business administration or related field or High School Diploma with five years relevant managed care experience

Special Qualifications:

Required:

• Excellent contract negotiation skills.
• Demonstrated knowledge and understanding of healthcare industry, including ongoing compliance with specialty regulatory requirements.
• Willingness to actively participate in all aspects of the contract administrative process. This is a hands-on working role as opposed to a lead and direct staff role.
• Exceptional and proven provider partnership skills and interpersonal skills.
• Results driven, persistent – able to self-direct and work independently showing initiative, while seeking guidance when appropriate.
• Demonstrated strength in various computer software including MS Office Suite, PowerPoint, as well as proficiency in utilizing social media platforms and internet-based research.
• Demonstrated effective written, verbal, and electronic communication that is professional in both content and delivery.
• Ability to work as a team member, take initiative, exercise independent judgment, decision-making, and problem-solving expertise.
• Must have a valid driver’s license and a satisfactory Motor Vehicle Record (MVR)

The Hughston Clinic, The Hughston Foundation, The Hughston Surgical Center, Hughston Clinic Orthopaedics, Hughston Medical, Hughston Orthopaedics Trauma, Hughston Orthopaedics Southeast and Jack Hughston Memorial Hospital participate in E-Verify. This company is an equal opportunity employer that recruits and hires qualified candidates without regard to race, religion, color, sex, sexual orientation, gender identity, age, national origin, ancestry, citizenship, disability, or veteran status.