This employee reviews payor contracts and information associated to contractual obligations including payor fee schedule changes and posted policy updates for various payors.
They will work with Managed Care Contract Administrators, Payor and Price Table Team, and other required departments to ensure that policy guidelines and changes are updated accordingly and timely.
JOB FUNCTIONS
- Contacts payors at times to discuss policies and / or changes
- Documents payor requirements according to their policies as well as payor changes and relays changes to the appropriate departments
- Pursues, maintains, and communicates medical guideline changes
- Helps facilitate interoffice communication on payor updates and changes
- Works with the Payor and Price Table team to ensure that policy changes are updated accordingly
- Works assigned payors accordingly and timely
- Available to assist other members on the team with questions and / or needs
- Answers payor policy questions accordingly
- Assists in identifying payor changes that need to be addressed
- Works with BIS, payor, and price table group to ensure that payor policies are followed and updated accordingly to payor guidelines once changes have been identified
- Communicates with the payor regarding policy information
- Assists with the delivery directives from Corporate office as they apply to policy changes and / or updates
Education
High School Diploma or General Education Degree (GED) Required
Knowledge, Skills, and Abilities
- Knowledge of the medical field preferred
- Basic computer skills
- Positive and cooperative attitude in working and communicating with individuals at all levels of the organization
- Write reports, business correspondence, and procedure manuals
- Effectively present information and respond to questions from groups of managers, clients,
customers, and the general public
- Telephone etiquette alongside adequate oral and written communication skills
- Shows effective multitasking skills
Contract Review Analyst
This employee reviews payor contracts and information associated to contractual obligations including payor fee schedule changes and posted policy updates for various payors. They will work with Managed Care Contract Administrators, Payor and Price Table Team, and other required departments to ensur...
Compliance Analyst
As an Entry-Level Compliance Analyst, you will play a crucial role in supporting our compliance projects and initiatives. Assist in Compliance Reviews: Support the team in evaluating policies, procedures, and practices to ensure compliance with federal regulations. Working under the guidance of expe...
Immigration Paralegal
Are you a highly skilled and passionate paralegal eager to elevate your career?. If so, you might be the exceptional paralegal we're seeking to join our rapidly growing immigration firm. The ideal candidate for this position will have at least three years of family-based immigration paralegal experi...
Pro Bono Paralegal
AI Justice is seeking a qualified and detail-oriented, full-time Paralegal to join our dynamic Pro Bono legal team. As a Pro Bono Paralegal, you will play a crucial role in supporting our attorneys by preparing legal documents, conducting research, and managing case files. ...
Construction Legal Assistant
Construction Litigation Legal Assistant. As a Construction Legal Assistant, you will:. A minimum of 3+ years of experience as a legal assistant in construction litigation and/or real estate. This role involves assisting attorneys in managing a wide range of legal tasks, including document preparatio...
Sr. Project Manager
Based on advanced experience, facilitate project planning including defining the project scope, goals, and deliverables, project tasks and resource requirements, and project plan and timelines for multiple, large, most complex projects. Track project deliverables using appropriate tools and adhering...
Glazing Project Manager
Reviews project proposal or plan to determine time frame, funding limitations, procedures for accomplishing project, staffing requirements, and allotment of available resources to various phases of project. Plans, directs, and coordinates activities of designated project to ensure that goals or obje...
Construction Project Manager
Providing strong leadership and supervision to project teams (including other Project Managers, Field Managers, Project Engineers, and field crews) and subcontractors. As a Project Manager for STRUCTURAL, you will be responsible for managing complex construction projects that make our nation’s struc...
Transmission & Distribution Project Manager
The primary responsibility of the Project Manager is to assist the Department Manager with overseeing the Utility services operations of the company through securing and successfully executing projects in accordance with the policies and procedures adopted by the company. The Project Manager is base...
Senior Project Manager
As a Senior Project Manager, you will be responsible for overseeing all aspects of complex commercial construction projects from inception to completion. My client is a leading commercial construction firm specializing in the development of high-quality projects throughout South Florida. You will pl...