For over 30 years, New Season Treatment Centers have been a leading national health care service provider of outpatient treatment centers that specialize in providing safe, quality and best in class care for individuals living with Opioid Use Disorder ("OUD"). Operating in over 70 treatment centers in multiple states, our team members are engaged in medication-assisted treatment, counseling, support, and care management of individuals living with OUD. We treat the whole person and, in so doing, address the underlying causes of OUD in an effort to provide a continuum of care that not only addresses treatment needs but supports the patient on their journey to recovery. Payor Relations Coordinator Job Description New Season Reports to: Director of Payor Relations Job Code: 164 Department: Payor Relations FLSA: Non-Exempt Direct Reports: 0
This position is responsible for participation in the analysis, implementation and follow-up of a variety of large-scale revenue cycle projects utilizing computer systems. Participates in all phases of projects, including but not limited to: planning, designing, developing, testing, implementing, training, troubleshooting, and reporting. This position is responsible for providing broad support to the Payor Relations team and is familiar with a wide variety of concepts, practices and procedures necessary to meet the goals of the department. This position reviews, reports and processes information, policies, and programs across all payers. This position resolves mutual issues between payers and Bayhealth typically involving claims processing and payment, contract intent, and procedural requirements. Payor Relations Coordinators are eligible for remote work arrangements, at the discretion of their leadership and must meet all requirements of the company telecommuting policy and department performance standards.
Facilitates, advises, and provides support to the revenue cycle team. Participates in the design, implementation, testing, enhancement, and RCM configurations. Manages the requirements of contracting for each individual plan to effectively implement rollouts to the clinics, monitor all stages of the contracting process, and plan application deadlines in order to update the department leadership. Develops and maintains good payer relations by ensuring all payor requested information is provided in a timely manner. Effectively identifies, communicates, and provides resolutions to issues with healthcare insurance plans. Establishes payer rate groups, billable services, fee schedules, CPT/HCPCS/ICD10 configurations and claim formatting. Maintains claims data in a HIPAA-compliant format with all content being cross-referenced against other databases to ensure accuracy and consistency of the data being reported. Provides oversight and management of the patient enrollment process for health insurance plans, state Medicaid entities, and Medicare for the company's multi-state clinics. Ensures that the terms of all contracting documents are accurate and in compliance with company policy. Establishes and maintains working relationships with all third-party payors, representatives and contract managers. Ensures contract language is followed and pertinent information is provided to company management. Organizes, maintains, and verifies all aspects of current files on practitioners. Ensures that all clinics/providers are credentialed with insurance plans and governmental payers. Reads all available memos, letters, or bulletins regarding the disposition of Medicare, Medicaid, third party health plans, and other pertinent collection memos. Maintains knowledge of current health plans and governmental payor requirements for credentialing clinics. Identify and facilitate any reporting requirements that may be present in contracts. Completes credentialing and recredentialing applications for insurance plans; monitors applications and follow-up as needed. Completes provider applications for state Medicaid plans; monitors applications and follow-up as needed. Maintains knowledge of current health plans and governmental payor requirements for credentialing providers. Keep lines of communication open with the Operations team to ensure individualized goals are met. Maintains confidentiality and safeguards the operations of business. Adheres to the service policy and principles of CMG/New Seasons. Other duties are assigned. Supervisory Responsibilities: (Scope of the person's authority, including a list of jobs that report to this job.) None Essential Qualifications: (To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the competencies (minimum knowledge, skill, and ability) required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions). Education/Licensure/Certification: This position requires a high school diploma or GED. Required Knowledge: The ideal candidate will be familiar with healthcare transaction sets including claims, verification, remittance, and authorization. Working with complex software systems, data tables, downloads, and data warehousing, and are critical knowledge bases. Additionally, the ideal candidate will demonstrate the ability to perform testing on records to produce custom output. Experience Required: The ideal candidate will have a minimum of 5 years of third-party healthcare insurance contracting experience. Experience working with database systems (i.e. SQL, etc.) and working knowledge of reporting/analytic tools (i.e. Crystal Reports, etc.) is preferred. Skill and Ability: The ideal candidate will demonstrate the ability to work collaboratively and value input from stakeholders within the organization. Requires excellent communication, analytical, facilitation and problem-solving skills including comfort with large data sets. Must have strong data management and computer skills including creating reports, development of spreadsheets, analyzing data, and manipulation of data from multiple data sources. Must have strong technical knowledge of revenue cycle operations with the ability to leverage data to identify process improvement opportunities and estimated financial benefit. Must have working knowledge of common revenue cycle key performance indicators. Must be a self-directed, strong team player with the ability to establish sound and effective goals and turn them into action. Must have the ability to successfully multitask and manage workflow priorities with attention to detail. Must have the ability to expand knowledge of various applications and other related tools to maximize potential. Physical Demands/Work Environment: (The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.) Finger Dexterity: Use primarily for writing, operating calculators, telephone, keyboard and other office equipment. Talking: To convey detailed or important instructions to employees, patients and applicants. Hearing: Ability to hear normal conversations and receive ordinary information. Vision: Average, ordinary, visual acuity necessary to observe patients and work on the computer. Clear vision at 20 inches or less and distant vision at 20 feet or more. Physical Strength: Sedentary work; sitting most of the time. Exerts up to 10 pounds of force occasionally. Working Conditions: (The working conditions described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.) Employees in the office environment must have the: Ability to operate in an open work area with moderate everyday noise. The position may be eligible to work in a remote location. In the remote telecommuting environment, the employee must have the: Ability to operate in a private workspace with a door that closes and locks. Ability to secure all work in a locking drawer or cabinet. Ability to travel occasionally to the support center for training. Core Competencies: Analytical Skills Business Acumen/Understanding the Organization Communication (oral & written) Detail orientation/Attention to Detail Ethics/Values/Integrity Information Gathering Problem Solving Time Management Mental Activities: (The mental activities described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.) Reasoning Ability: Ability to resolve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram or schedule form. Ability to maintain confidentiality. Mathematics Ability: Ability to calculate figures and amounts using basic mathematics, including statistics. Language Ability: Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, and governmental regulations. Ability to write reports and business correspondence. Ability to effectively present information and respond to questions from groups of managers, employees, patients and the general public. Highschool Diploma Knowledge of Medical Insurance Good Customer Service Skills Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled