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Tulane University · 1 month ago

Payor Relations & Reimbursement Manager

Harahan, LA

Full-time

Onsite

Entry, Mid Level

2+ years exp

Tulane University is seeking a Payor Relations & Reimbursement Manager responsible for maintaining the TUMG Master Fee Schedule and conducting in-depth payer reimbursement analysis. This role involves ensuring contract compliance, resolving payment discrepancies, and optimizing revenue cycle operations through collaboration with internal teams and external vendors.

EducationHigher EducationMedical

Responsibilities

Responsible for maintaining TUMG Master Fee Schedule, tracks payer fee schedule updates and coordinates with vendors to ensure timely and accurate uploads and performing in-depth payer reimbursement and variance analysis, supporting payer negotiations, and advising on strategic pricing decisions

This role ensures contract compliance, coordinates with A/R team to resolve over/underpayments, and supports efforts to optimize revenue cycle operations and reimbursement accuracy through collaboration with internal teams, payor relations, and third-party vendors

Qualification

Managed care knowledgeData analysis skillsMedical coding knowledgeRevenue cycle managementData visualization toolsMS Office proficiencyCommunication skillsOrganizational skillsTime management skillsConfidentiality

Required

Deep understanding of managed care, government contracts, and reimbursement processes

Strong data analysis skills with the ability to compile and interpret complex data sets related to contract compliance and payment trends

Excellent communication and interpersonal skills for working with internal teams and external payer representatives

Extensive knowledge of medical coding systems (ICD, CPT, HCPCS, etc.) and payer fee schedules

Ability to maintain confidentiality in all work performed

Excellent organizational and time management skills; ability to effectively manage multiple tasks simultaneously and meet established deadlines

Excellent skills using MS Word, Excel, and PowerPoint

Bachelor's Degree with two (2) years' experience in revenue cycle management, medical coding, and payer payment variances

Preferred

Master's Degree: minimum four (4) years' experience in healthcare setting preferred

Demonstrated proficiency in the utilization of Data Visualization tools such as Power BI

Experience with hospital or clinical charge description master (CDM) and payer fee schedules; knowledge of global fees, professional fees, and technical fees; experience in medical billing, collections, and coding practices and procedures

Company

Tulane University

Glassdoor4.1

A member of the prestigious Association of American Universities, Tulane University is consistently ranked among the top 50 universities in the nation.

Founded in 1834

New Orleans, Louisiana, USA

1001-5000 employees