The Payer Strategy Manager is responsible for assisting with the strategic planning and execution of payer contracting with commercial and government payers on behalf of Springfield Clinic. Works closely with departmental staff and Clinic physicians to develop and maintain a portfolio of participating network contracts that align with the Clinic's payer strategy. Utilizes data to provide oversight of current contracting and strategically develop further contracting opportunities. Provides general assistance and backup support to the Director of Managed Care.

Job Relationships

Reports to the Director of Managed Care

Principal Responsibilities

• Collaborate directly with the Director of Managed Care and all Operations staff to support all payer strategy and contracting business needs.
• Collaborate with patient accounting, quality management, practice operations and credentialing teams as directed to ensure that all payer contractual obligations are met.
• Maintain relationships with provider relations representatives with all contracted managed care plans.
• Work closely with payers to ensure proper understanding of payer's guidelines, contractual terms, and the processing of Springfield Clinic claims.
• Perform research to determine viability and strategic benefit to new contracting opportunities.
• Provide verbal and written communication to all applicable Springfield Clinic practice operations, ancillary, and billing teams related to payer contract initiative implementation
• Maintain all associated documentation for all health plan/payer contracting terms.
• Provide administrative coordination and oversight of payer contracts in accordance with contract goals, objectives, and activities.
• Provide insight, direction, and support to credentialing specialists including but not limited to network status, issues related to credentialing, and answering all questions related to payer plans.
• Provide applicable payer reporting.
• Comply with the Springfield Clinic incident reporting policy and procedures.
• Adhere to all OSHA and Springfield Clinic training & accomplishments as required per policy.
• Provide excellent customer service and adhere to Springfield Clinic's Code of Conduct and Ethics Standards.
• Perform other job duties as assigned.

Education/Experience

• Bachelor's degree in business, healthcare administration, or other related field is required.
• Minimum two (2) years' experience in health care related payer relations/contracts is required.
• Microsoft Office experience is required.

Knowledge, Skills and Abilities

• Ability to produce reports and analyze data is required.
• Strong verbal and written communication skills are required.
• Must have strong group presentation skills.

Working Environment

• This job operates in a professional office environment.
• Routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.
• Most of the time will be spent in the office, with occasional travel possible.

PHI/Privacy Level

HIPAA1