Payer Relations Manager

HearingLifeis a national hearing care company and part of the Demant Group, a global leader in hearing healthcare built on a heritage of care, health, and innovation since 1904.HearingLifeoperates more than 600 hearing care centers across 42 states. We follow a scientific, results-oriented approach to hearing healthcare thatis provided byhighly skilledand caring professionals. Our vision is to help more people hear better through life-changing hearing health delivered by the best personalized care.

Position Summary:

Reporting to the Director of Payer Relations this position manages current contracts for assigned portfolio, new contracts, contract renewals and negotiations including assessment of historical performance and issues, identification of payer specific issues as well as opportunities and recommendations which incorporate strategic and critical thinking approaches resulting in desired outcomes. The Payer Relations Manager is responsible for managing payer contract lifecycle for his/her assigned portfolio and continually identifies and evaluates new opportunities. The manager establishes, fosters, and maintains positive relationships with payers to optimize contract terms and negotiate favorable rates. This role requires a deep understanding of audiology group and hearing aid benefit reimbursement methodologies, the ability to analyze and synthesize large data sets, and a commitment to maintaining the highest level of data integrity. Acts as an internal consultant and will work collaboratively with many cross-functional teams within HearingLife.

Purpose Statement:

To help more people hear better by ensuring the best experience for Team Members and meets the highest standards of patient services while achieving financial growth for HearingLife clinics in a manner consistent with HearingLife's Core Values.

• Obtains and catalogs fully executed current payer contracts into Payer Relations data repository along with up-to-date fee schedules, and payer contact information.
• Manages the lifecycle of all contracts in the assigned portfolio ensuring terms and fee schedules are optimally aligned with business objectives.
• Monitors new contract leads and existing contract renegotiations processes confirming fully executed contracts are received and cataloged with fee schedule and payer contact information.
• Responds to assigned market requests by performing independent research, collecting data, and analyzing data to respond to field inquiries. Collaborates on responses under the guidance of the Director Payer Relations.
• Research assigned geographical areas to identify new opportunities with payers, self-insured employers, and partnerships. Initiates contact with targeted organizations to obtain potential agreements. Summarizes agreement and models' potential revenue to determine value of contract.
• Monitors, quantifies, and facilitates resolution of payer issues identified by the Revenue Cycle Team. Collaborates on developing and implementing an action plan for payment resolution by leveraging contacts at the payer.
• Develops, maintains, and continuously fosters relationships with payers, unions, associations, medical groups, and self-funded employers. Manages the communication outreach, value propositions, and documents efforts in the contract management system as appropriate.
• Replies to payer compliance attestation requests, quality, and reporting requirements by providing clinical outcomes or data required by payors.
• Partners with the Revenue Cycle Team to develop an intake and approval process for single case agreements or one-time negotiations. Ensures approved agreements are communicated timely to the providers.
• Responsible for tracking, redlining, and analyzing new contracts, amendments, and rate proposals.
• Establishes trust and credibility by fostering a positive relationship with Senior Executives, People Leaders, and Departments supporting revenue cycle.
• Stays apprised of legislative efforts related to insured and uninsured patients, educating others, and recommending organizational changes to programs as a result.
• Acts as subject matter expert for Learning and Development to create training modules and tools as part of operationalizing new contractual agreements. Communicates plan specific payer requirements to all stakeholders.
• Remains current with trends, regulatory requirements, and business strategies related to the payer relations and revenue cycle.
• Operates in compliance with all local, state, and Federal laws as well as HearingLife policy and compliance standards.
• Maintains knowledge of current computer systems (i.e., POS, DM, AX, etc.).

This job description is not intended be an inclusive list of responsibilities. Duties, responsibilities, and activities may change, or new ones may be assigned at any time with or without notice.

• Bachelor's degree in Business, Finance, Healthcare Management, or Information Technology required.
• Master's degree preferred.
• 5+ years-experience in payer contracting and negotiations.
• Knowledge of ICD, CPT, and HCPCS coding systems.
• Expertise in network development processes, contract language, principles of negotiation and credentialing.
• Ability to analyze and interpret contracts, key performance metrics and performance reports.
• High attention to detail with ability to analyze and summarize data.
• Ability to work independently and as part of a team with all levels of leadership.
• Strong critical thinking skills and the ability to manage and prioritize multiple projects required.
• Advanced Microsoft Office skills - Excel, Power Point, Word, and Visio.
• Strong computer skills relevant to the position required. Considerable experience using Excel, PowerPoint and Word required.
• Proven ability to drive performance, metric outcomes and collaborate cross-departmentally to help meet and exceed organizational goals.
• Initiative-taker who excels in a fast paced, data driven, complex work environment.
• Knowledge of and ability to articulate explanations of Medicare, Medicaid, HIPAA, EMTALA, No-Surprise Act as well as other government assistance programs and regulations.

Come be part of a team where every day brings new challenges, learning, and the opportunity to make a difference. Join us!

We are an Equal Opportunity / Affirmative Action employer, all qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, sex, national origin, disability, or protected veteran status.

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