Keplr Vision ยท 3 days ago
Director - Payor Relations
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Keplr Vision provides business support & supply chain management services along with partnering options in the optometrist medical industry. The Payor Relations Director leads and maintains relationships involved in the contracting process and develops negotiation strategies to grow exams and contracts within Keplr locations.
Business DevelopmentHealth Care
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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
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Required
5+ years of experience with a Multi-Practice Group, or Managed Vision Care Payor
Optometry/Ophthalmology experience with emphasis in Payor Relations or Contracts
Knowledge of CPT/HCPC codes and terminology required
Prior fee analysis and negotiations experience required
Advanced excel skills are necessary
Strong organizational skills, accuracy, and attention to detail
Leadership/Relationship skills to interact with internal and external constituents from entry level to CEO
Preferred
Actuarial experience/qualifications highly desirable