Contract Manager-Payor Relations

Overview

Contract Manager Payor Relations

The Payor Contract Manager at Nationwide Children’s Hospital is responsible for payor contracting activities including:  negotiating assigned managed care contracts with third party payors; monitoring payment accuracy and key contractual terms of assigned payor contracts; implementing assigned payor contracts throughout the NCH system; developing communication vehicles and educational tools designed to educate and assist staff in meeting contractual requirements; and serving as a liaison between the health plans and key departments throughout NCH (e.g., case management, patient financial services, medical staff, etc.).

Schedule: (Full time, Remote in Ohio, Benefits Eligible)

Location:

Remote [Candidates must reside in Ohio]

Why Nationwide Children's Hospital?

The moment you walk through our doors, you feel it. When you meet our patient families, you believe it. And when you talk with anyone who works here, you want to be part of it. Welcome to Nationwide Children’s Hospital, Where Passion Meets Purpose.

Here, Diversity, Equity and Inclusion are integrated into our core values and practices. We are passionate about building, sustaining and evolving an inclusive and equitable environment. We are seeking individuals who live these values and want to share their experiences and efforts in support of our collective mission.

We’re 14,000 strong. And it takes every one of us to improve the lives of the kids we care for, and the kids around the world we’ll never meet. Kids who live healthier, fuller lives because of the knowledge we share. We know it takes a Collaborative Culture to deliver on our promise to provide the very best, innovative care and to foster new discoveries, made possible by the most groundbreaking research. Anywhere.

Ask anyone with a Nationwide Children’s badge what they do for a living. They’ll tell you it’s More Than a Job. It’s a calling. It’s a chance to use and grow your talent to make an impact that truly matters. Because here, we exist simply to help children everywhere.

Nationwide Children’s Hospital. A Place to Be Proud.

Responsibilities

• Establish and maintain relationships with managed care plans and third party payors. Utilizing all available resources to prepare and maintain demographic, statistical and biographical payor profiles. Serves as the “information expert” on all payors.
• Negotiates, manages, and maintains documentation for payor/managed care contracts with third party payors for Nationwide Children’s Hospital and its affiliated subsidiaries (e.g., Nationwide Children’s Homecare Services and physician groups).
• Implement payor/managed care contracts throughout the organization. Actively engages payor and NCH staff to validate key implementation terms.
• Manage and report on payor contract adherence, e.g. administrative and payment.
• Coordinate payor/managed care contracting efforts with internal clinical resource management activities.
• Identify, document and resolve adverse and inappropriate payor trends relative to expectations.
• Serves as primary informational and resolution contact for NCH constituents.
• Provide ongoing reporting, analysis, and trouble-shooting support for the Payor Relations Department.
• Responsible for ensuring external contract rate loading and internal verification of contract rates.
• Lead and contribute to other projects and initiatives as directed by Director of Payor Relations

Qualifications

KNOWLEDGE, SKILLS AND ABILITIES REQUIRED:

Education:

• Minimum requirement of Bachelor’s degree in business or related field with Master’s degree in health services and/or business administration preferred;

Required Experience:

• Proven leadership track-record, along with 3-5 years of previous management experience in leading and coordinating efforts of staff;
• At least 5-7 years of experience in negotiating facility, physician, home health, behavioral health and other provider types;
• Proven ability to facilitate teamwork with physicians and clinical leadership;
• Excellent communication, organizational, writing, and analytical skills;
• Working knowledge of hospital and physician coding and billing;
• Interest in excelling and in assuming progressively more responsibility in dynamic health care environment.

Minimum Physical Requirement:

• Sitting   (Constantly)
• Talking on phone or in person  (Frequently )   
• Typing on a keyboard (Frequently  )
• Standing/walking  (Occasionally )

EOE/M/F/Disability/Vet.