Apply on Employer Site

Prosperity Behavioral Health · 2 days ago

Payer Relations & Contracting Specialist

United States

Full-time

Onsite

Mid, Senior Level

$65K/yr - $70K/yr

5+ years exp

Prosperity Behavioral Health is dedicated to transforming the business side of behavioral health by providing innovative solutions that enhance financial performance. The Payer Relations and Contracting Specialist will manage relationships with payers and negotiate contracts to secure optimal reimbursement rates for clients, ensuring they receive the best possible support for their services.

FinanceFinancial ServicesFinTechHealth Care

No H1B

Hiring Manager

Clarissa Apple, PHR

Responsibilities

Develop and maintain positive relationships with payers, including insurance companies and government agencies

Lead complex negotiations with payers to secure favorable reimbursement rates and contract terms, ensuring alignment with company and client goals

Conduct thorough market analysis to understand current trends, reimbursement benchmarks, and competitive rates to inform contract strategies and decisions

Ensure all contracts comply with relevant federal, state, and local regulations, as well as industry standards and best practices

Address payer inquiries and resolve billing disputes in a timely manner

Monitor payer performance and identify opportunities for improvement

Utilize data analytics to track and analyze payer performance, reimbursement trends, and financial outcomes, providing actionable insights to clients and internal stakeholders

Collaborate with internal teams, such as billing and coding, to ensure accurate and timely submission of claims

Develop and implement strategic plans for payer contract management, including identifying opportunities for new payer relationships and optimizing existing ones

Provide expert support and consultation to clients regarding payer contracts, reimbursement strategies, and payer relationship management to enhance their financial performance and operational efficiency

Stay informed on industry trends and changes in payer reimbursement methodologies

Provide training and support to internal teams on payer-related issues and processes

Catalog, update, and maintain contracted rates and fee schedules for each of our clients

Support provider and facility credentialing needs, including organizing and documenting requirements, maintaining a database and managing appropriate systems

Leverage internal company systems and tools, such as CredentialStream and external systems, such as CAQH, to accomplish goals and provide a high standard of customer support

Qualification

Payer relationsContract negotiationData analyticsBehavioral health experienceStakeholder collaborationCommunication skillsTech-savvyHealthcare administrationAttention to detailInterpersonal skills

Required

Bachelor's degree in healthcare administration, business, or a related field, or relevant experience in the Behavioral Health industry

Minimum of 5 years of experience in payer relations and contracting, ideally in Behavioral Health

Strong analytical and negotiation skills

Excellent communication and interpersonal skills

Knowledge of payer reimbursement methodologies

Ability to effectively collaborate with internal and external stakeholders

Attention to detail and ability to manage multiple tasks simultaneously

Tech-savvy with proficiency in utilizing data analytics and business intelligence tools for advanced decision-making

Benefits

401(k)

Dental insurance

Employee assistance program

Flexible spending account

Health insurance

Health savings account

Life insurance

Paid time off

Vision insurance

Remote work location

Company

Prosperity Behavioral Health

Prosperity Behavioral Health provides sophisticated, data-driven revenue cycle and back office services, hands-on training and support, and comprehensive strategy and finance consulting to behavioral health companies.

Founded in 2017

Cherry Hill, New Jersey, USA

51-200 employees