Keplr Vision · 8 hours ago

Director - Payor Relations

United States

Full-time

Remote

Lead/Staff, Director/Executive

5+ years exp

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Responsibilities

Build data models to forecast and monitor payor rates by code

Assist in key Projects - i.e. Analysis Lab vs NonLab Models, Obtain practice data, Fee schedule consolidation, etc.

Building and maintaining relationships with payors, including resolving disputes, and identifying opportunities for network expansion

Managing contract renewals and amendments

Communicate and educating departments on new payors and plans, and providing guidance on contract-related issues

Collaborating with internal and external stakeholders to ensure accurate billing and payment processes

Evaluate new payors/networks and their fees for participation

Thoroughly analyze and review rates and utilization to drive mutually beneficial outcomes for patients and providers

Analyze fee schedules by specialty and code relative to historical company utilization

Track contracts and anniversary dates to ensure annual rates are implemented correctly and on time

Maintain the tickets submitted to Payor Relations through Fresh Service

Assist in developing and maintaining appropriate policies, procedures, and controls for Optometry contracts and payor contracting activity

Other duties as assigned

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

Payor Relations experienceOptometry/Ophthalmology experienceCPT/HCPC codes knowledgeFee analysis experienceAdvanced Excel skillsActuarial experience