MD EyeCare Services Corporate

  • Payor Contracts Manager

    Job Locations US-TX-Dallas
    Posted Date 3 days ago(3 days ago)
    Job ID
    2018-2731
    # of Openings
    1
    Category
    EyeCare Services Partners
    Type
    Regular Full-Time
  • Overview

    ESP Logo

    Eyecare Services Partners is a nationally recognized leader in Ophthalmic and Optometric care with dynamic leadership, excellent clinical support teams and an unwavering commitment to customer service and patient care.  We strive to make every interaction extraordinary, inspiring the complete confidence of our patients, partners and employees.  Our employees contribute directly to the success of our practices and take pride in being a member the ESP Management team. We strongly believe that the manner in which our patients, customers and employees is as important as the quality of the services we provide.

     

    The Payor Contracts Manager (“PCM”) works closely with the Finance and Revenue Cycle Departments of the Company, responsible for conducting and documenting complicated payor analysis, providing insight’s and information to support the Company’s payor strategy initiatives, continuous monitoring of revenue realization, and payor negotiations.   The PCM will develop and maintain payor contracting database, maintain fee schedules in the NextGen system, and analyzes payor payments.

    Responsibilities

    Roles and Responsibilities

    • Prepares and maintains fee schedules by payer for each contracting entity in NextGen
    • Prepares and maintains Claim Payment Parameters by payor
    • Prepares, analyzes, and takes action of high dollar trending of aged payor claims
    • Monitors payer compliance with accuracy of payments.
    • Identifies significant reasons for non-compliance, prioritizes based on frequency of occurrence and/or $ impact, and works with payer to eliminate/reduce non-compliance.
    • In coordination with Credentialing and Provider Recruitments, manages Payer and Network participation by physician
    • Maintains Payer Contracting Database, “the Grid”, ensuring accuracy of information, timeliness of updates and user friendly access.
    • Compiles and maintains Contract Summary Manual, with appropriate distribution, using Contract Summary template for each significant payer, ensuring accuracy, timeliness, and completeness of information.
    • Determines market level payment rate range and annually recommends minimum threshold rate for contracted payers.
    • Annually updates expected payment rates by payer in support of ESP’s budget preparation.
    • On a quarterly basis, prepares and distributes Payer Analysis Report for ESP and each market. Reports show payer mix percentages by financial class and major payers.
    • Prepares payor proposals, manages the negotiation process, and negotiates language and financial reimbursement terms with payors.

    Qualifications

    Required Skills and Experience

    • Bachelor’s degree in Finance, Accounting, Business or Economics is preferred .
    • Minimum 3-5 years of financial, revenue cycle, managed care experience required.
    • Experience in analysis and health care payor contracts required.
    • Experience in optometric or ophthalmology practices management is preferred.
    • Experience with NextGen software preferred, other healthcare practice management software required.

     

    In turn we will offer:

    • Benefits to full time team members that include comprehensive medical, dental and optical coverage, 401K and short and long term disability.
    • Company paid life insurance.
    • Paid holidays and generous paid time off.
    • Paid parking where applicable.
    • Team oriented working environment where you are heard and respected.
    • Clear career ladder opportunities.

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