Payer Relations Representative

SUMMARY

The Payer Relations Representative is the primary resource for internal and external customers insuring overall contract implementation and compliance for Children's Colorado. The Payer Relations Representative works directly with contractors and networks teams by ensuring that contracts are correctly implemented for operational compliance.

Additional Information
Department Name: Managed Care
Job Status: Full time, 40 hours per week.
Shift: Monday to Friday 8am-5pm, Hybrid.

POPULATION SPECIFIC CARE

No direct patient care.

ESSENTIAL FUNCTIONS

An employee in this position may be called upon to do any or all the following essential functions. These examples do not include all the functions which the employee may be expected to perform.

1. Develops and distributes educational materials and communications. Conducts in-services for internal departments, staff and network members regarding contract provisions by applying and interpreting knowledge of contractual terms.
2. Schedules, prepares and conducts standardized monthly, quarterly and ad-hoc meetings with both network members, and multiple organizations to address problems and/or issues through resolution. Participate in payer forums as necessary.
3. Analyzes complex payer information and reports, including updated payer policies or procedures, to provide accurate in-depth analysis and timely recommendations or communications to key individuals and leadership as well as third parties.
4. Maintains and updates an effective tracking system of all payer credentialing materials as required for payer contracts. Facilitates the dissemination of monthly rosters.
5. Independently resolves issues between parties, organizations or providers. Determines action required to resolve problems or issues and coordinates with other departments as needed to ensure resolution.
6. Develops communication strategy for providing timely and accurate information on payer policies and procedures as well as processes on a regularly scheduled basis. Participates in the initial orientation of newly contracted services related to payer contracts and their requirements.
7. Implements processes to ensure adherence to protocols established by Children's Colorado or other institutions. Participates in and supports initiatives and shares expertise and bandwidth throughout the system as required. Functions as liaison between institutions and organizations assisting with problem solving and resolutions.
8. Operates as a subject matter expert, whose expertise is relied on by peers, leadership and business partners. Participates in professional development activities to keep current with trends and practices. Performs on special projects as directed.
   

SCOPE AND LEVEL

Guidelines: Guidelines are generally but not always clearly applicable, requiring the employee to exercise judgment in selecting the most pertinent guideline, interpret precedents, adapt standard practices to differing situations, and recommend alternative actions in situations without precedent.

Complexity: Duties assigned are generally complex and may be of substantial intricacy. Work assignment is performed within an established framework under general instructions but requires simultaneous coordination of assigned functions or projects in various stages of completion.

Decision Making: Exercises judgment and discretion, and is responsible for determining the time, place and sequence of the work performed.

Communications: Contacts with the public or employees where explanatory or interpretive information is exchanged, defended, and gathered and discretion and judgment are required within the parameters of the job function.

Supervision Received: Performs work with minimal supervisory oversight. Under general supervision, the employee receives assignments and is expected to carry them through to completion with substantial independence. Work is reviewed for adherence to instructions, accuracy, completeness, and conformance to standard practice or precedent. Recurring work clearly covered by guidelines may or may not be reviewed.

MINIMUM QUALIFICATIONS

EDUCATION - Bachelor's degree.

EXPERIENCE - 3 years Payer Relations, Network Management, Contracting, or similar background.

EQUIVALENCY - Related work experience may substitute for education requirements on a year for year basis.

Salary Information
Pay is dependent on applicant's relevant experience.

Annual Salary Range (Based on 40 hours worked per week): $66,083.89 to $99,125.84

Benefits Information
Here, you matter. As a Children's Hospital Colorado team member, you will receive a competitive pay and benefits package designed to take care of your needs that includes base pay, incentives, paid time off, medical/dental/vision insurance, company provided life and disability insurance, paid parental leave, 403b employer match (retirement savings), a robust wellness program, and access to professional development tools, including an education benefit to help you advance your career.

As part of our Total Rewards package, Children's Colorado offers an annual employee bonus program that rewards eligible team members based on organizational performance. If organizational goals are met for the year, the bonus is paid out the following April.

Children's Colorado delivers annual base pay increases to eligible team members based on their performance over the previous year.

EEO Statement
It is our intention that all qualified applicants be given equal opportunity and that selection decisions be based on job-related factors. We do not discriminate on the basis of race, color, religion, national origin, sex, age, disability, or any other status protected by law or regulation. Be aware that none of the questions are intended to imply illegal preferences or discrimination based on non-job-related information. The position is expected to stay open until the posted close date. Please submit your application as soon as possible as the posting is subject to close at any time once a sufficient pool of qualified applicants is obtained.

Colorado Residents: In any materials you submit, you may redact or remove age-identifying information such as age, date of birth, or dates of attendance at or graduation from an educational institution. You will not be penalized for redacting or removing this information.