Title: Payor Contracting and Rate Negotiations Expert

RESPONSIBILITIES:

  • Seeking a highly experienced individual with hands-on experience negotiating payor contracts and fee schedules for our clients.
  • Results driven expert that has a proven track record of increasing payor fee schedules.
  • Thorough understanding of contract language.
  • Auditing codes and fee schedules – Benchmarking reimbursements against local Medicare Rates to identify weaknesses in their current reimbursements.
  • Thorough understanding of CPT Codes and reimbursement language.
  • Ability to speak with our clients to determine what’s important to their practice and to have a thorough understanding of the provider’s specialty(s).
  • Ability to educate our clients on proper coding.
  • Thorough understanding of HCFA’s, EOB’s and claim denials in order to assist educate our clients and assist with clean claims.
  • Audit and determine our clients practice’s high-volume procedures; understanding of E/M codes, ICD-9’s, etc.
  • Understand if the practice does consultations, preventive exams, in-house labs, X-rays, injections, supplies, and other services that are valued outside the ‘traditional’ RBRVS fee schedule, before contacting any payer.
  • Ability to write clear and precise impactful proposal letters to the networks and have key contacts at the networks.
  • Seeking an individual with in-depth knowledge and experience with payor contracts, fee schedules, coding, reimburements, etc.

SKILLS/EXPERIENCE/EDUCATION:

  • Medical Biller/Coder Certification a plus, but not required.
  • College degree desired but not required.
  • Ideal candidate must be highly self-motivated with proven expertise in the healthcare physician credentialing, expirables management, and medical licensing experience is a plus.
  • Ability to perform multiple assignments, good organizational, and time management skills.
  • Strong clerical and computer skills.
  • Strong organizational and follow up skills.
  • Proficiency in Microsoft Office. Knowledge of credentialing software is helpful, but not required.
  • Ability to interact effectively with a variety of people (physicians, mid-levels, medical staff offices, ancillary staff, and insurance reps).
  • Provides the highest level of customer service to our customers.
  • Strong written and verbal communication skills.
  • Strong presentation and client interaction skills.