Manager, Payor Compliance

Could you be our next Manager, Payor Complicance at Radnor, PA?

Why work as a Manager, Payor Compliance within our Magnet Health System?

• Make an Impact! The Manager of Payor Compliance reports to and supports the Director of Contract Analytics and Payor Compliance in monitoring and enforcing payer compliance with all contract terms. This position works in concert with Revenue Cycle, legal and other staff to investigate systemic underpayment issues, analyze impact and improve our overall revenue by collaborating with payers to resolve payer compliance issuesin a timely manner. The Manager of Payor Compliance will also provide support for contract negotiations for the Director and VP of Payer Strategies by modeling physician and ancillary proposals. This position will work cooperatively with, provide education for and support other members of the Payor Strategies department and Revenue Cycle. Manager of Payor Compliance will also assist in policy and fee schedule impacts for hospital, physician and ancillary services.
  
  
• Develop and Grow Your Career! Take advantage of our Tuition Reimbursement Program! This position is eligible for up to $6,000 per year based upon your Full or Part Time status.
  
  
• Join the Team! Like our patients, the Main Line Health Family encompasses a wide range of backgrounds and abilities. Just as each of our patients requires a personalized care plan, each of our employees, physicians, and volunteers, bring distinctive talents to Main Line Health. Regardless of our unique design, we all share a common purpose: providing superior service and care.
  
  
• Position-Specific Benefits include: You are eligible for up to 240 hours of paid time off per year. We also offer a number of employee discounts to various activities, services, and vendors... And employee parking is always free!
  
  

Position: Manager, Payor Compliance
Shift: Dayshift

Experience:
Essential Accountabilities:

* Review paid and underpaid claims data to identify underpayments to recover lost revenue, collaborate with Revenue Cycle and legal to ensure payment compliance and work with payors in a timely manner to improve cash flow.
* Identify root cause of any recurring and systemic issues that negatively impact payment. Provide resolution, and suggest favorable language improvements for contract negotiations.
* Model physician and ancillary services to provide support during negotiations.
* Verify hospital contract model build for hospital contract negotiations.
* Provides oversight of payor compliance by developing a tracking tool and report payor compliance to leadership.
* Continually strives to suggest improvements that will provide new or better insight to the organization.
* Works to identify systemic payer issues reflected in Epic resulting from contract management build.
* Maintain continual knowledge of payor policies to assure optimal reimbursement for all services performed within the system, in compliance with government and third-party payor regulations
* Serves as a subject matter expert on payor compliance and reimbursement rules.

10+ experience in healthcare billing/accounts receivable/ contract management required

Education:
4 Year / Bachelors Degree or 15+ years of experience in healthcare billing, accounts receivable, and/or contract management required