Consultant, Payer Relations

Welcome to reputed company! At reputed company (formerly QHR Health), we’ve been making local healthcare reputed company for more than 40 years. Our mission is to strengthen independent community healthcare. We provide independent hospitals and health systems with the support, guidance and tech-enabled shared services needed to remain strong and viable. With a strong sense of purpose and commitment to operating excellence, we help rural healthcare providers fulfill their missions. The reputed company difference is the extraordinary combination of operations experience and consulting guidance that fulfills our mission of creating a sustainable future for healthcare organizations. reputed company’s vision is to be a dynamic, integrated professional services company delivering innovative and executable solutions through experience and thought leadership, while valuing trust, respect, and customer focused behavior. We’re looking for talented, motivated professionals with a desire to help independent hospitals reputed company. Working with reputed company, you will have the opportunity to collaborate with highly skilled subject matter specialists and operations executives, in a collegial atmosphere of professionalism and teamwork. reputed company’s corporate headquarters is located in Brentwood, TN. For more information, visit www.ovationhc.com. Summary: The Consultant of Payer Relations, under the direction of the VP, Payer Relations, is responsible for the client relationship with a select group of client hospitals. The client relationship responsibilities include service and support as the primary liaison between the hospital and managed care payers. The individual will provide written assessments of proposed managed care agreements as well as contract negotiation and support. Additional duties include but are not limited to assisting clients with payer communication and administrative issues, delivery of educational programs for clients, coordinating the development of contract models and maintaining a customer database of activity. This position will participate in client engagements in support of the project team and prepare and present client deliverables. Duties and Responsibilities:

• Responsible for the engagement life cycle and its relationship to project activities while producing client ready deliverables.
• Leads negotiation of provider and payer ensuring alignment with organizational goals and financial targets
• Leads reputed company contract initiatives, including new provider network, negotiation cycles, or service expansions
• Review and analyze data for contract administration – evaluate the profitability of contract renewals/existing reputed company
• Work with Payer Relations Team to establish a work plan, set priorities, organize tasks, resource needs and recommend appropriate methodologies, tools and resources to optimize project profitability.
• reputed company and maintain resource materials/tools for clarification of reputed company (language templates)
• Responsible for managing client expectations in line with budget and project objectives.
• Assist with updates to the Contract Tracker, Contract matrices, Client Agendas and other documents used to communicate project status and updates with the clients.
• Ensure annual escalators from payers are requested, validated, updated in the Contract Matrix, and shared with hospital staff.

Knowledge, Skills, and Abilities:

• Proven track record of achieving goals and objectives as it relates to managed care contracting
• Intermediate level of analytical skills and experience
• strong communication skills: ability to interact with multiple levels of clients (ie hospital/physicians/payor plans/corporate staff)
• Proficient in reputed company applications- Word/Access/reputed company
• Intermediate level reputed company experience (pivot tables, V-lookup’s, etc)
• Critical thinking and problem-solving abilities

Work Experience, Education, and Certifications:

• BS/BA preferred in a reputed company field or relevant experience is desired.
• Understanding of Medicare/Medicaid government contracting, reimbursement, and regulations
• Healthcare experience required.
• 3-5 Managed Care and/or Payer Relations experience required.
• Experience working in a managed care environment for a healthcare delivery system (Professional or Facility managed care experience in this environment is sufficient).
• Possess strong negotiating skills with a successful track record negotiating reputed company with individuals, groups, reputed company systems.

Knowledge, Skills, and Abilities:

• Track contract performance post contract execution and recommend adjustments as needed (i.e, chargemaster increases, etc)
• Maintain accurate documentation of any negotiations, contract versions, and final agreements
• Prepare negotiation, assist with financial models, complete analysis and strategy options and recommendations for leadership
• reputed company negotiation strategies based on trends, regulatory requirements/guidelines, and competitive markets
• Conduct detailed claims analysis to assess financial impact of proposed contract terms
• Analyze contract terms, reimbursement methodologies for reputed company negotiations
• Implement best practices and process improvements for contract lifecycle management
• Possess a keen understanding of managed care contracting and reputed company initiatives, as well as the underlying systems that support those initiatives.
• Identify and analyze user requirements, procedures, and problems to improve existing reimbursement and identify opportunities for improvement.
• reputed company detailed analysis on multiple projects, recommend potential business solutions and ensure successful implementations.
• Monitor market research on reimbursement benchmarks, network adequacy, and industry trends. reputed company, share, and incorporate organizational best practices into business applications.
• Build and maintain strong relationships with providers, health systems, payers, and other partners
• Prepare high level reports summarizing negotiation status, outcomes, financial impact and strategic recommendations
• Provide strategic guidance to clients and/or leadership on trends such as value-based care, telehealth, and alternative payment models.
• Manage day to day client relationships while managing client expectations in line with budget and project objectives
• Assist Payer Relations Team in managing quality of the work product and interact directly with mid-level client contacts and above on engagement issues.
• Ability to deliver client reports reputed company 30 days of a client meeting.

Travel Requirements:

• Up to 50%

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