Payer Contracting Specialist - USA Clinics Group

The Contracting and Payor Relations Specialist (Payer Contracting Specialist) partners with the Manager of Contracting and Payor Relations on the implementation of payor strategy, focusing on payor operations, client services, and process improvement. The focus of this role is network development/contracting. In addition,this role ensures resolution of payor issues received from the field, leadership, or other internal departments, tracking of opportunities, and continual documentation and improvement of processes.

This position works onsite in our Northbrook, Illinois corporate office. Remote work is not an option. 

Responsibilities

• Negotiation of managed care agreements with payors, health systems,  IPA’s and other entities Including language and rate negotiation.
• Working knowledge of various reimbursement strategies and ability to analyze rate proposals.
• Ability to identify unfavorable contract language in agreements.
• Assist with implementation of payor strategy in partnership with the Manager of Contracting and Payor Relations.
• Maintains a thorough operational knowledge of contractual agreements and specific contractual language with Payors.
• Coordinate with credentialing regarding demographic updates and needs related to contracting efforts.
• Collaborates with Operations, legal, billing, and compliance to track and resolve payor issues, including payment and/or billing disputes.
• Continually create, document, and improve processes to provide clear communication throughout the lifecycle of contracting efforts.
• Determine and implement any tools or technology required to assist in providing communication and updates to leadership and other relevant stakeholders.
• Manages contract assignments and any documentation relevant to the negotiation, strategy, and/or implementation of the contract.
• Proactively monitor and report current contracting efforts.
• Partner with internal team to ensure that contracting efforts align with company and divisional goals.
• Communicate with relevant stakeholders to ensure contract commitments are operationalized.
• Additional duties as assigned

Requirements

• Bachelor’s degree, Required
• At least 1-3 years managed care contracting experience, preferably with a provider, Required
• Prior health care provider or health plan contracting, contract operations, service operations, or provider relations experience, required.

This position works onsite in our Northbrook, Illinois corporate office. Remote work is not an option. 

Benefits

• Health insurance with dental and vision
• PTO with sick time
• 401k & match