Payer Strategy Contract Specialist
CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources CommonSpirit is committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community.
The Contract Specialist will support all operational efforts to effectively improve reimbursement from out-of-network payers, with an emphasis on compliance and performance related to federal and state No Surprises regulations.
Essential functions include:
- Perform the tasks needed, as noted below, to accurately follow company standards and procedures related to out-of-network claim disputes, including:
o Research and evaluation of claim data, and submission of claim disputes into relevant internal and external systems; with an emphasis on accuracy and timeliness.
o Create and maintain shared folders in an organized fashion to promote efficiency and create accurate historical records
o Independently assess, and effectively communicate with Revenue Cycle or other departments, what information is needed and by when to ensure compliance with timelines
o Communicate with payers to inform them of disputes, and engage with them in negotiations to settle disputes prior to arbitration or other escalation; ensuring that such activities comply with company criteria.
- Assist with, or lead, report development or activity tracking to accurately reflect performance of out-of-network reimbursement dispute processes and outcomes
- Assist with development of policies and procedures, communication and training materials, and tools needed to prepare for, and optimize, CommonSpirit Health’s financial performance related to out-of-network payer reimbursement.
- Support the Director, as needed, with program management and oversight for out-of-network (OON) payer disputes and NSA-related initiatives across CommonSpirit Health.
- Support and contribute to CommonSpirit Health’s PSR, Revenue Cycle, and Physician Enterprise knowledge base through sharing best practices, learnings regarding the NDA, key metrics, and other applicable work streams.
- Bachelor’s degree or equivalent education and experience
- Minimum of three (3) years’ negotiation and revenue cycle experience in a healthcare related field (hospital or payer)
- Knowledge and experience in reimbursement, the financial aspects of contracting and managed care operations
- Strength in effective negotiation and project management skills
- Excellent written and verbal communication skills
- Expertise and experience with Excel and Word, Google Suite and/or similar applications
A compensation range of $52,000 - $68,000 is the reasonable estimate that CommonSpirit in good faith believes it might pay for this particular job based on the circumstances at the time of posting. CommonSpirit may ultimately pay more or less than the posted range as permitted by law.
While you’re busy impacting the healthcare industry, we’ll take care of you with benefits that include health/dental/vision, FSA, matching retirement plans, paid vacation, adoption assistance, annual bonus eligibility and more!
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