Payer Relations Specialist - Pilot

PAYER RELATIONS SPECIALIST

The Payer Relations Specialist assists with the administrative oversight of payer contracts on behalf of ROMTherapy. Works closely with Payer Relations Management to maintain the details of participating network contracts, assist in acquisition of new Payer contracts and supports the Payer Relations Team in responding to Single Case Agreements and in tracking outcomes of all Payer Relations contracts communications and activity. Provides internal support and general assistance and support to the Director of Managed Care, Payer Relations Management and ROMTherapy Credentialing resources. Reports to the Director of Managed Care Responsibilities

Collaborates directly with the Director of Managed Care and Payer Relations Management to support all payer relations business needs.

Possess in-depth knowledge and understanding of payer's guidelines, contractual terms, and the processing of ROMTherapy claims to provide direction and guidance to all internal departments.

Responds to payer contract questions as well as benefit and billing questions

Coordinates with revenue cycle, and credentialing teams to ensure that all payer contractual obligations are met.

Rectifies day to day issues for provider service representatives and others within practice operations

Maintains relationships with provider relations representatives with all contracted managed care plans.

Identifies issues to discuss in recurring payer meetings.

Provides verbal and written communication to all applicable ROMTherapy practice operations, ancillary, and billing teams related to updates of payer information such as payer provider manuals, provider bulletins and other notices relating to eligibility, covered services, pre-authorization requirements, coding and claim requirements, appeal processes, etc.

Analyzes and coordinates execution of single case agreements and requested contracts including communications with other teams.

Responds promptly to client needs and solicit feedback to improve service, meet commitments and provide follow-up within a timely manner.

Develops training aids and trains staff on the use of online portals and other tools utilized to obtain prior authorizations in compliance with all payer plans to maximize efficiency

Provides excellent customer service and adhere to ROMTherapy's Code of Conduct and Ethics Standards.

Performs other job duties as assigned.