Payor Contract Specialist

At Cleveland Clinic Health System, we believe in a better future for healthcare. And each of us is responsible for honoring our commitment to excellence, pushing the boundaries and transforming the patient experience, every day.

We all have the power to help, heal and change lives beginning with our own. That's the power of the Cleveland Clinic Health System team, and The Power of Every One.

Job Title

Payor Contract Specialist

Location

Independence

Facility

Business Operations Center

Department

RCM Clinical Denials HB-Finance

Shift

Days

Schedule

8 : 00am-4 : 30pm

Job Summary

Join the Cleveland Clinic team, where you will work alongside passionate caregivers and provide patient-first healthcare. Cleveland Clinic is recognized as one of the top hospitals in the world. At Cleveland Clinic, you will receive endless support and appreciation and build a rewarding career with one of the most respected healthcare organizations.

Job Details

As a Payor Contract Specialist, you will be responsible for collecting and analyzing managed care contract information to support effective contract implementation, compliance monitoring, operational efficiency and customer service initiatives. You will disseminate contract details to provider organizations, facilities, and operational departments, ensuring alignment and understanding across all stakeholders. In addition, you will research and recommend solutions to issues related to claim payments, reimbursement and operational processes. This role plays a key part in facilitating the resolution of outstanding claims to optimize revenue and promote patient satisfaction.

A caregiver in this position works remotely from 8 : 00 a.m. 4 : 30 p.m., with flexible start times available as early as 7 : 00 a.m. or as late as 9 : 00 a.m.

Responsibilities

Collect and assimilate managed care contract information to support contract implementation, compliance monitoring, operations and customer service functions.

Act as an internal resource to community hospitals, institutes and other internal departments.

Provide contract-specific information and resolution of issues to payors and internal customers.

Research, track and manage issues related to claim payment, reimbursement, operations and general information requests.

Manage and track escalated, high-profile and highly complex issues, making recommendations to resolve them.

Negotiate case-specific agreements with local, regional, national and international payors for tertiary referrals, as well as agreements for other services and Cleveland Clinic facilities.

Gather, research and distribute contract-related information for compilation, communication and implementation.

Prepare communications, summary sheets, quick reference guides and implementation checklists for assigned payor contracts.

Contribute materials for the Managed Care newsletter and websites.

Coordinate informational sessions for payor contract implementation and education.

Arrange and facilitate meetings with payor representatives for contract maintenance or problem resolution.

Minimum Qualifications

Bachelor's Degree in Business, Marketing, Healthcare or a related field

OR High School Diploma / GED and three years of related experience

Strong desktop computer skills (Word, Excel, Access, PowerPoint, Outlook)

Ability to relate effectively to physicians and hospital administration and to handle service issues and complaints in a professional and diplomatic manner

Revenue and claim review experience

Preferred Qualifications

One year of managed care or provider relations experience

Communication with payer experience

Excel skills Word and PowerPoint

Experience in a remote position

Physical Requirements :

Ability to communicate and exchange accurate information.

Ability to perform work in a stationary position for extended periods.

Ability to work with physical records or operate a computer or other office equipment.

In some locations, ability to travel throughout the hospital system.

In some locations ability to move up to 25 lbs.

Personal Protective Equipment :

Follows standard precautions using personal protective equipment as required.

The policy of Cleveland Clinic Health System and its system hospitals (Cleveland Clinic Health System) is to provide equal opportunity to all of our caregivers and applicants for employment in our tobacco free and drug free environment. All offers of employment are followed by testing for controlled substance and nicotine. All new caregivers must clear a nicotine test within their 90-day new hire period. Candidates for employment who are impacted by Cleveland Clinic Health System's Smoking Policy will be permitted to reapply for open positions after one year.

Cleveland Clinic Health System administers an influenza prevention program. You will be required to comply with this program, which will include obtaining an influenza vaccination on an annual basis or obtaining an approved exemption.

Decisions concerning employment, transfers and promotions are made upon the basis of the best qualified candidate without regard to color, race, religion, national origin, age, sex, sexual orientation, marital status, ancestry, status as a disabled or Vietnam era veteran or any other characteristic protected by law. Information provided on this application may be shared with any Cleveland Clinic Health System facility.

Cleveland Clinic Health System is pleased to be an equal employment employer : Women / Minorities / Veterans / Individuals with Disabilities.