- Collaborates directly with the Director of Managed Care and Payer Relations Manager to support all payer relations business needs.
- Possess in-depth knowledge and understanding of payer's guidelines, contractual terms, and the processing of Springfield Clinic claims to provide direction and guidance to all internal departments.
- Responds to payer contract questions as well as benefit and billing questions
- Coordinates with revenue cycle, quality management, practice operations and credentialing teams to ensure that all payer contractual obligations are met.
- Rectifies day to day issues for provider service representatives and others within practice operations
- Receive, research, and perform service recovery as needed
- Maintains relationships with provider relations representatives with all contracted managed care plans.
- Identifies issues to discuss in recurring payer meetings.
- Partner with patient accounting and compliance colleagues to resolve individual cases of improper reimbursement and identify trends.
- Provide verbal and written communication to all applicable Springfield Clinic practice operations, ancillary, and billing teams related to updates of payer information such as payer provider manuals, provider bulletins and other notices relating to eligibility, covered services, pre-authorization requirements, coding and claim requirements, appeal processes, etc.
- Analyze and coordinate execution of single case agreements and requested contracts including communications with other teams.
- Facilitate meetings, display willingness to make decisions within scope of responsibility, and include the appropriate people in the decision-making process.
- Utilize critical thinking and problem-solving skills when addressing payer, office, and provider concerns
- Respond promptly to client needs and solicit feedback to improve service, meet commitments and provide follow-up within a timely manner.
- Develop training aids and train staff on the use of online portals and other tools utilized to obtain prior authorizations in compliance with all payer plans to maximize efficiency
- Build strong relationships and instill confidence and trust at all levels of the organization including providers.
- Attends workshops, seminars, and other training programs for educational growth.
- Comply with the Springfield Clinic incident reporting policy and procedures.
- Adhere to all OSHA and Springfield Clinic training & accomplishments as required per policy.
- Provide excellent customer service and adhere to Springfield Clinic's Code of Conduct and Ethics Standards.
- Perform other job duties as assigned.
- Associates Degree in business, healthcare administration, or equivalent experience is required. Bachelors degree is preferred.
- Conceptual knowledge of principles and practices of healthcare related payer relations/contracts.
- Strong communication skills are required
- Ability to manage multiple tasks and work in a fast-paced environment is required.
- Must be detail oriented and able to deliver a high level of accuracy.
- Must be proficient in all MS Office applications, including Excel, Access, PowerPoint and Word.
- Ability to define problems, collect data, establish facts, and draw valid conclusions.
- Ability to effectively present information and respond to questions from staff and management across the Clinic.
- Must consistently exercise discretion and sound judgement
- This job operates in a professional office environment.
- Routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.
- Occasional travel possible.
-
Client Relation Specialist
2 weeks ago
A BETTER LIFE HOMECARE LLC Springfield, United StatesPay: $ $22.00 per hour · Experience level: · - 2 years · Shift: · - 8 hour shift · - Morning shift · Weekly day range: · - Monday to Friday · Work setting: · - In-person · - Office · Ability to Commute: · - Springfield, MA preferred) · Ability to Relocate: · - Springfield, MA 011 ...
-
Public Relations Specialist
1 week ago
Market Mentors Springfield, United States**Public Relations Specialist** · **POSITION IN-OFFICE in SPRINGFIELD, MA** · - **Less than 25 miles from Hartford, CT** · The primary function of this job is establishing and maintaining relationships with members of the media by writing and pitching press releases and other med ...
-
Employee Relations Specialist
2 weeks ago
Associated Electro-Mechanics Inc Springfield, United StatesJob Description · Job DescriptionWe are seeking a Employee Relations Specialist to become a part of team You will be responsible for managing HR & payroll activities for the organization. This critical role works closely to support the overall operations of the organization, with ...
-
Public Relations Specialist
1 week ago
Alight Illinois, United States RegularRole · As the Public Relations Specialist at Alight, you will report to the Senior Manager of Public Relations and oversee PR objectives. Your role involves collaborating with Marketing and Product teams to execute external communications. This will include media relations, prod ...
-
DOC Labor Relations Specialist
1 week ago
State of Illinois Springfield, United StatesThe Labor Relations Specialist, serves as a representative of Management in a Labor Relations setting. This position performs highly confidential, sensitive administrative tasks in a diverse agency. This position serves as the liaison of Management f Relations, Labor Relations, S ...
-
DOC Labor Relations Specialist
3 days ago
State of Illinois Springfield, United StatesAgency: Department of Corrections · Closing Date/Time: 06/03/2024 11:59pm · Salary: Anticipated Starting Salary: $7,660; Anticipated Starting Salary Range: $7,660-$8,600/month · Job Type: Salaried · County: Sangamon · Number of Vacancies: 1 · Plan/BU: None · A RESUME IS REQUIRED ...
-
Human Resources Employee Relations Specialist
3 weeks ago
Phoenix Home Care & Hospice Springfield, United StatesWe are adding an HR Employee Relations Specialist to our Springfield Phoenix family Do you have a passion for making a difference in someone's life? Are you looking for an opportunity to use your background and empathetic nature to work for a progressive, forward-thinking company ...
-
Commercial Insurance Client Relations Specialist
3 weeks ago
Nixon & Lindstrom Insurance Springfield, United StatesNixon & Lindstrom Insurance is seeking an experienced Commercial Lines Client Relations Specialist to service and manage a commercial lines book of business and aid our sales team in marketing and binding new accounts. · Duties/Responsibilities: · Assist clients with customer s ...
-
Nixon & Lindstrom Insurance Springfield, United StatesNixon & Lindstrom Insurance is seeking someone to join our team as a Commercial Lines Client Relations Specialist. This person will provide service to a commercial lines book of business and aid our sales team in marketing and binding new accounts. · Duties/Responsibilities: · As ...
-
Human Resources Employee Relations Specialist
4 weeks ago
Phoenix Home Care & Hospice Springfield, United StatesWe are adding an HR Employee Relations Specialist to our Springfield Phoenix family Do you have a passion for making a difference in someone's life? Are you looking for an opportunity to use your background and empathetic nature to work for a progressive, forward-thinking company ...
-
Human Resources Employee Relations Specialist
2 weeks ago
Phoenix Home Care & Hospice Springfield, United StatesWe are adding an HR Employee Relations Specialist to our Springfield Phoenix family Do you have a passion for making a difference in someone's life? Are you looking for an opportunity to use your background and empathetic nature to work for a progressive, forward-thinking company ...
-
Human Resources Employee Relations Specialist
3 weeks ago
Phoenix Home Care & Hospice Springfield, United StatesWe are adding an HR Assistant to our Springfield Phoenix family Do you have a passion for making a difference in someone's life? Are you looking for an opportunity to use your background and empathetic nature to work for a progressive, forward-thinking company where creativity is ...
-
Nixon & Lindstrom Insurance Springfield, United StatesNixon & Lindstrom Insurance is seeking an experienced Commercial Lines Client Relations Specialist to service and manage a commercial lines book of business and aid our sales team in marketing and binding new accounts. · Duties/Responsibilities: · Assist clients with customer s ...
-
Phoenix Home Care and Hospice Springfield, United StatesJob Description · Job DescriptionWe are adding an HR Employee Relations Specialist to our Springfield Phoenix family Do you have a passion for making a difference in someone's life? Are you looking for an opportunity to use your background and empathetic nature to work for a prog ...
-
Help Desk Specialist
3 weeks ago
Ascension Federal Services Inc. Springfield, United States**Help Desk Specialist**: · **Location**:Springfield**, VA, 20598**: · **Clearance: TS/SCI** · **The Help Desk Specialist will provide technical support and assistance to end-users regarding software, hardware, and network-related issues. The specialist will be responsible for tr ...
-
Housing Specialist
2 weeks ago
Housing Court Department Springfield, United States**ALL APPLICANTS MUST APPLY DIRECTLY THROUGH THE TRIAL COURT EMPLOYMENT PAGE LINKED BELOW.** · **IF YOU APPLY THROUGH THE APPLY ONLINE LINK ABOVE ON THIS MASS CAREERS PAGE YOU **WILL NOT BE CONSIDERED** FOR THIS POSITION.** · **PLEASE USE THE FOLLOWING LINK TO APPLY (CUT AND PAST ...
-
Performance & Engagement Specialist
2 weeks ago
BEHAVIORAL HEALTH NETWORK, INC. Springfield, United States**Are you a talented Performance & Engagement Specialist with a passion for creative, solution focused, fast moving human resource development?** · Be a **changemaker** with us We're looking for a great **Specialist** to join the team · **Behavioral Health Network **(**BHN**) is ...
-
Test Technician
3 weeks ago
EVERSOURCE Springfield, United StatesEversource Energy is the largest Energy delivery company in New England. We support 4.4 million Gas and Electric customers across CT, MA and NH. We're proud to provide safe, reliable service to 4.4 million electricity, natural gas and water customers. Be a part of our mission to ...
-
Allergy Territory Account Specialist
1 week ago
Novartis Springfield, United States**About the Role**: · Allergy Territory Account Specialist - Springfield, MA - Remote · Allergy Territory Account Specialist - Portland, ME - Remote · This is a field-based and remote opportunity. · Novartis is more than an organization. It is a thriving community where talented ...
-
Mental Health Support Specialist
1 week ago
BEHAVIORAL HEALTH NETWORK, INC. Springfield, United States**Share your commitment to individual empowerment and growth, human rights, and community integration** · Join our team of competent and compassionate professionals as a Support Specialist in the Program for Assertive Community Treatment (PACT) at Behavioral Health Network · **Yo ...
Payer Relations Specialist - Springfield, United States - Springfield Clinic
Description
The Payer Relations Specialist assists with the administrative oversight of payer contracts on behalf of Springfield Clinic. Works closely with Payer Relations Manager to maintain the details of participating network contracts. Provides internal support so that contractual obligations can easily be met while enhancing revenue and patient access and provides general assistance and support to the Director of Managed Care and Payer Relations Manager.
Job Relationships
Reports to the Director of Managed Care
Principal Responsibilities
Education/Experience
Knowledge, Skills and Abilities
Working Environment
PHI/Privacy Level
HIPAA1
