Job Description

Job Description: Healthcare Payer Manager

Location: Charlotte, NC

Industry: Healthcare

Salary Range: $70,000 - $90,000

Position Summary

The Healthcare Payer Manager plays a pivotal role in fostering and maintaining relationships with internal and external stakeholders. This individual will participate in the development of contractual language, negotiation strategies, and compliance monitoring to ensure that providers receive appropriate reimbursements while adhering to regulatory and contractual requirements. Additionally, this role involves oversight and management of appeals related to the No Surprises Act to ensure compliance and favorable outcomes.

Key Responsibilities

• Provide oversight of the entire appeals process under the No Surprises Act, ensuring compliance with strict timelines and guidelines to achieve favorable resolutions.
• Manage tracking systems for payment activities, fee adjustments, and offer submissions related to appeals and payer interactions.
• Address and resolve ineligible or inconsistent determinations while monitoring preferences for external entities.
• Build and maintain strong working relationships with payer representatives, collaborating with Revenue Cycle Management (RCM) and Contracting teams to facilitate effective communication and issue resolution.
• Develop and maintain analytics capabilities to benchmark utilization and reimbursement trends across the organization’s network.
• Evaluate new payer networks and assess participation fees for alignment with organizational goals.
• Partner with external consultants and third-party contractors to enhance payer relations and ensure best practices are implemented.
• Conduct thorough analyses of rates, fee schedules, and utilization data to drive mutually beneficial agreements between payers and providers.
• Monitor contracts and track anniversary dates to ensure timely implementation of negotiated rates and terms.
• Quantify the impact of rate changes during negotiations and continuously evaluate fee adjustments and utilization trends.
• Assist in the development and implementation of policies, procedures, and controls to support effective payer contracting and compliance activities.

Qualifications

• Exceptional organizational and time management skills.
• Highly analytical with strong attention to detail.
• Proven ability to manage multiple priorities and meet tight deadlines.
• Strong interpersonal and communication skills for effective stakeholder management.
• Flexible and resourceful, capable of adapting to evolving project requirements.

Preferred Experience

• Familiarity with healthcare payer regulations, appeals processes, and compliance requirements, including the No Surprises Act.
• Experience in contract negotiation, provider relations, or healthcare operations is highly desirable.

If you are detail-oriented, strategic, and passionate about optimizing payer-provider relationships, we encourage you to apply for this exciting opportunity in the dynamic healthcare industry.

Addison Group is an Equal Opportunity Employer. Addison Group provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, genetic information, marital status, amnesty, or status as a covered veteran in accordance with applicable federal, state and local laws. Addison Group complies with applicable state and local laws governing non-discrimination in employment in every location in which the company has facilities. Reasonable accommodation is available for qualified individuals with disabilities, upon request.  

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