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SoluStaff is recruiting for an O&P/DME Payor Contract Relations Manager, for its customer, a global healthcare company. This position is responsible for managing payor contracts in the clinical care setting. This includes all duties related to payor contracts including pursuing and obtaining new insurance contracts, process management, and execution of new contracts, as well as all necessary contractual amendments, changes, and renewals. This person will act as an expert resource for contract issue escalation, and resolution of high-level compliance and customer-related concerns. This is a hybrid position based in Austin, Texas and will require several days in office/week with proof of COVID vaccination or legitimate exemption.

Requirements

• Perform contract review of new and renewing contracts, including pricing and language negotiations.
• Manage the implementation, execution, and communication of new/modified contracts throughout the organization.
• Establish a strong working relationship with insurance payors and serve as a liaison between the insurance payor and the Company.
• Review fee schedules provided by payors prior to implementation to determine impact and prepare practice-facing materials to ensure transparency around contracted rates.
• Responsible for completion and submission of credentialing and recredentialing applications and securing required supporting documentation.
• Responsible for managing payor contract portfolios on a regular basis including monitoring, tracking, and touchpoints.
• Resolve escalated contract issues generated by operational department heads.
• Draft and communicate customer announcements for newly executed, terminated, or revised/updated contracts and payor industry news.
• Provide feedback to appropriate customer personnel regarding insurance payor requirements.
• Oversee the maintenance of customer demographic information for locations and notification of revisions to payors.
• Work collaboratively with payors and functional teams (e.g., Legal/Compliance, Finance, Centralized Billing, and IT) on strategic business development efforts to ensure geographic maximization, plan and service types, and optimal reimbursement rates.
• Maintain knowledge of current health plans and governmental payor requirements.
• Other special projects and tasks as necessary.

Knowledge, Skills, and Abilities:

• Strong working knowledge of managed care contracting, contracting language, insurance networks, and reimbursement methodologies.
• Must be observant, conscientious and detail oriented.
• Effective organizational, time management, and planning skills to meet deadlines.
• Successful negotiation skills.
• Strong PC skills, with database and reporting proficiency.
• Exceptional communication skills for organized, accurate, and audience appropriate messaging, both written and verbal, to internal and external audiences. Comfortable giving presentations.

Minimum Qualifications (Education, Experience, Certification, & Licensure):

• Bachelors degree or 3-5 years of directly related experience in contract administration and management in health care industry.
• Experience in O&P or DME contracts highly preferred.

Benefits

• Health Care Plan (Medical, Dental & Vision)
• Life and AD&D coverage
• Short and Long-term Disability
• Retirement Plan (401k with matching)
• Paid Time Off (Vacation, Sick & Public Holidays)