Revenue Cycle- Payer Contract Analyst

Job Description

Payer Relations manages the overall DSO/Plan relationship and is the dental plans primary point of contact. Payer Relations is responsible for negotiation and management of contracts with dental insurance plans as well as the overall payer strategy on behalf of Riccobene Associates. Payer Relations serves as a resource to all areas and provides timely guidance on payer issues. Payer Relations may act as an intermediary between other Riccobene Associates departments and/or practices and the dental plan in resolving non-routine issues once available options have been explored/exhausted by all parties directly involved. Position is remote.

Responsibilities

As a Contract Negotiator, you will be responsible for designing, recommending, and executing strategies for structuring payer relationships, including payer and plan participation or non-participation. You will initiate contract negotiations and renegotiations with dental plans. You will be responsible for negotiating competitive payer reimbursements and terms within all contracts to result in improving the competitive position of Riccobene Associates in the marketplace. You will fully understand and negotiate provider group contracts.

More specifically, you will:

• Independently negotiate and draft fee for service or value based contractual language and competitive reimbursement contracts with all types of dental plans on behalf of Riccobene Associates providers. Contracts pose a mid to high level degree of difficulty and must adhere to corporate standards, goals, and budget.
• Act as a professional resource to answer all contractual questions posed by providers and/or internal departments within the organization, including but not limited to, participating in the dispute resolution process for providers in accordance with payer contracts, participating in workshops and in-services.
• Work with internal cross-functional teams to provide guidance and direction on all assigned contracts, regulatory changes, payer relationship management and policy and procedural changes.
• Provide clear, concise, and timely reporting to C-suite and/or other leadership staff. Track and report on progress of payer network development including significant developments and changes to key DSO payer contacts or networks. Ensures the company is appropriately advised and strategically aligned on payer issues.
• Be able to multitask in a highly fluid environment.
• Review or prepare rate proposals and counters, model new rates and compare reimbursement to determine contract value and potential revenue impact. This includes comparing rate proposals to existing rate schedules and making recommendations supported by data to decision makers.
• Drive all aspects of payer negotiations.
• Conduct research, data collection and final assessment/resolution of contractual terms and issues.
• Proactively research payer policy changes that impact company. Distribute information as necessary
• Continuously monitor contract performance and value, identifying new targets for renegotiation or regular contract adjustment (COLA).
• Remain current with trends, regulatory requirements, and business strategies related to the payer relations.
• Recommend periodic adjustments to the Company’s fee schedules (UCRs).
• Operate in compliance with all local, state, and Federal laws as well as Riccobene Associates policy and compliance standards.
• Job description is not intended to include an inclusive list of responsibilities. Duties, responsibilities, and activities may change, or new ones may be assigned at any time with or without notice.

Qualifications

Skillsets we are looking for:

• Have a Bachelor’s degree in a healthcare, business, finance, Marketing, Communications or a related field.
• Have 7 to 10 years-experience in provider relations, payer relations or financial analysis within a healthcare organization or payer. May consider qualified candidates in lieu of a bachelor’s with 5-7 years of directly related contracting experience. Experience may run concurrently.
• Demonstrate thorough understanding or ability to learn provider network requirements including but not limited to credentialing and accreditation, network participation, complex reimbursement methodologies, contract performance measures.
• Understand the reimbursement and the payer mix in various geographic territories as well as how changes affect provider reimbursement.
• Have excellent written and verbal communication and presentation skills along with the ability to effectively communicate complex concepts and contracts to all levels of employees and providers.
• Have excellent interpersonal skills along with the proven ability to successfully negotiate complex provider contracts, manage provider/group contract negotiations, and resolve problems with tact and diplomacy.
• Are comfortable and confident with frequent payer facing interactions (via teleconferencing, in-person meetings, e-mail, and phone).
• Have the ability to learn quickly, prioritize and handle multiple competing priorities with successful outcomes.
• Have proven problem-solving skills and ability to independently analyze and dissect provider contracts, relationships and issues and create workable win-win solutions for both the payer and Riccobene Associates.
• Have proficient skills using PC based applications to develop and report on payer activity using Microsoft Office and other data visualization programs.
• Must have the ability and willingness to travel to attend on-site visits, association meetings, presentations, etc. Position is remote. Travel is expected to be less than 20%.

• Medical Practice

Full-time

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