Georgia Employer SR. PAYOR RELATION SPECIALIST in Atlanta, Georgia
Northside Hospital is award-winning, state-of-the-art, and continually growing. Constantly expanding the quality and reach of our care to our patients and communities creates even more opportunity for the best healthcare professionals in Atlanta and beyond. Discover all the possibilities of a career at Northside today.OCCUPATIONAL SUMMARYProvides broad support to the managed care team and is familiar with a wide variety of concepts, practices and procedures necessary to meet the goals of the department. Works closely with the practices, billing teams and health plans to successfully transition new providers into the Northside system and professional healthcare plans. Serves a wide variety of customers both internally and externally to maintain said transition to include members of managed care, professional billing, practice management, revenue integrity, recruitment and the healthcare plansPRIMARY DUTIES AND RESPONSIBILITIESResponsible for a broad range of provider relations and service interactions between Northside Hospital Managed Care and the health plan providers.Serves as a liaison between Northside\'s professional billing staff and the health plans to assist in the resolution of systemic claim issues and denials. Issues are not limited to provider loading errors and may include plan adjudication errors and/or problematic billings.Diligently seeks assistance from the plans as needed and works swiftly to monitor and close the loop on issues as quickly as possible.Works closely with the practices, billing staff and revenue integrity as needed to resolve issues and to recognize root cause scenarios to better serve the network as a whole. Seeks out assistance from the Managed Care Contracting team as needed to understand and educate on contract requirements and streamline problem solving.Responds effectively and timely to internal teams requesting various types of information. Requests may include assisting with provider onboarding and advising on plan load status or plan information. Educating and assisting with delegated credentialing plan requirements or plan submittal processes. Providing reimbursement allowable information. Seeking out policy information from plans to resolve issues related to denials, coding, authorization or referrals.Produces quality work and contributes a positive attitude towards building successful relationships with others. Has the ability to juggle multiple projects with multiple deadlines often with minimal direction and supervision. Knows how to prioritize. Resourceful and seeks out answers.REQUIRED:Bachelors Degree or equivalent work experience of no less than 5 years in the area of provider relations.Strong understanding of hospital reimbursement methodologies.Strong understanding of activities, practices, tools and considerations for managing the claims adjustment process.Experience with contract modeling software.Two (2) years of Negotiation experience.Ability to work independently.Strong analytical skills 8. Excellent organizational skills.Excellent communication skills.Strong working knowledge of computer spreadsheet programs and database programs such as Access.PREFERRED:McKesson/HBOC Trendstar CPA.Microsoft Excel and AccessNorthside Hospital is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, gender identity, sexual orientation or protected veteran status.