Loading...
Share this Job

Payer Operations Manager

Location:  Park North - Harvard 
Requisition #:  44628

JOB SUMMARY

Tracks, manages, and communicates the status of assigned third party payer issues and operational initiatives.  Facilitates designated meetings with payers toward actionable outcomes. Collaborates with the Director, Managed Care Operations to identify strategic solutions and coordinate proactive follow-up and reactive issue management with appropriate representatives from both external and internal stakeholders.

EDUCATION

• Bachelor’s Degree in Business or health-related discipline; or equivalent experience in lieu of degree

CERTIFICATION SUMMARY

• No professional certifications required

EXPERIENCE*

• 3 years of experience working at a payer or provider in a relevant role involving provider/payer relationships
• Experience with revenue cycle operations

PREFERRED QUALIFICATIONS*

• N/A

KNOWLEDGE SKILLS & ABILITIES*

• Well-developed organizational, communication and interpersonal skills
• Must be able to work with confidential information 
• Advanced PC skills
• Excellent analytical and problem-solving skills
• Ability to research and analyze concepts and details
• Ability to document and succinctly present research findings
• Ability to explain, present or discuss difficult information and gain group consensus
• Ability to work within deadlines and resource constraints
• Ability to interact effectively with managers, staff and outside stakeholders
• Ability to function effectively as a part of a team

JOB RESPONSIBILITIES*

1. Facilitates and manages assigned third-party payer operations meetings, monthly claims calls, or ad-hoc meetings in coordination with Revenue Cycle and CPG to ensure operational issues are being addressed in an efficient manner.
2. With the Director, Managed Care Operations, develops and implements strategies to administer Children’s contracts with third-party payers, whilst preserving Children’s contractual rights.  
3. Builds and maintains strong collaborative relationships with both third party payers and internal stakeholders. Communicates identified payer operational issues to both internal and external parties, acting as mediator and troubleshooter in disputes with third party payers.
4. Develops, tracks and maintains project plans and strategies for assigned third party payers.  Identifies possible solutions to overcome roadblocks/barriers to internal stakeholders and leadership. Serves as a resource for internal stakeholders to troubleshoot complex authorization, claim or denial issues.
5. In coordination with Managed Care Contracting, Revenue Cycle, Utilization Review, CPG, Performance Analytics, and Service Lines, ensures all issues are being addressed, updated and communicated.
6. Reviews third party payer correspondence or communication for potential issues that would impact both operational and clinical processes.  In coordination with Performance Analytics and Finance Project Management, provides detail for Children’s mitigation strategy. Communicates regular notifications to multiple departments informing them of changes in third party policies and requirements.
7. Assists Director, Managed Care Operations, Director, Managed Care Contracting and Vice President, Managed Care to complete strategic and business plans as required by Children’s.
8. Performs other activities related to Children’s managed care activities, as requested.
9. Supports and participates in the continuous assessment and improvement of the quality of care and services provided.
 

SYSTEM RESPONSIBILITIES*

Safety: Practices proper safety techniques in accordance with hospital and departmental policies and procedures. Responsible for the reporting of employee/patient/visitor injuries or accidents, or other safety issues to the supervisor and in the occurrence notification system.

Compliance: Monitors and ensures compliance with all regulatory requirements, organizational standards, and policies and procedures related to area of responsibility. Identifies potential risk areas within area of responsibility and supports problem resolution process. Maintains records of compliance activities and reports compliance activities to the Compliance Office.

 

PHYSICAL DEMANDS*
Ability to lift up to 15 lbs independently not to exceed 50 lbs without assistance
Bending/Stooping - Frequently (activity or condition exists from 1/3 to 2/3 of time)
Climbing - Occasionally (activity or condition exists up to 1/3 of time)
Hearing/Speaking - Effective communication with employees, supervisors/managers and staff. Effective communications with patients and visitors, as required.
Lifting - Occasionally (activity or condition exists up to 1/3 of time)
Pushing/Pulling - Occasionally (activity or condition exists up to 1/3 of time)
Sitting - Frequently (activity or condition exists from 1/3 to 2/3 of time)
Standing - Occasionally (activity or condition exists up to 1/3 of time)
Walking - Occasionally (activity or condition exists up to 1/3 of time)
WORKING CONDITIONS*
No potential for exposure to blood and body fluids

 

About Us:

Children’s Healthcare of Atlanta has been 100 percent committed to kids for more than 100 years. A not-for-profit organization, Children’s is dedicated to making kids better today and healthier tomorrow.

With 3 hospitals, 27 neighborhood locations and a total of 638 beds, Children’s is the largest healthcare provider for children in Georgia and one of the largest pediatric clinical care providers in the country. Children’s offers access to more than 70 pediatric specialties and programs and is ranked among the top children’s hospitals in the country by U.S. News & World Report.

Children’s has been ranked on Fortune magazine’s list of “100 Best Companies to Work For” for fourteen consecutive years and named one of the “100 Best Companies” by Working Mother magazine. We offer a comprehensive compensation and benefit package that supports our mission, vision and values. We are proud to offer an array of programs and services to our employees that have distinguished us as a best place to work in the country. Connect to our mission of making kids better today and healthier tomorrow. 

Have questions about the recruitment process?  Check out What to Expect.

Address:  3375 Northeast Expressway, Atlanta, GA  30341
Function:  Finance/Accounting - Managed Care


Nearest Major Market: Atlanta

Job Segment: Manager, Pediatric, Project Manager, Management, Healthcare, Technology