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Payor Relations Specialist - Government Relations

  • Job
    Full-time
    Senior Level
  • Business, Operations & Strategy
  • Boston

Requirements

  • A Bachelor's Degree or Equivalent Experience in Business, Finance, Healthcare Admin, or Health Information Management and 5 or more years of progressive experience in provider or health plan setting
  • Basic knowledge of healthcare reimbursement, administrative, and payment methodologies
  • Ability to analyze and interpret complex data, identify trends, and assist in developing actionable insights
  • Excellent communication (oral and written) and interpersonal skills, with the ability to effectively engage with payor representatives and internal stakeholders
  • Proactive attitude with a willingness to take initiative, adapt to changing priorities, and drive results in a dynamic environment.
  • Ability to work both independently and collaboratively within a team setting
  • Detail-oriented with strong organizational skills, including ability to multi-task and manage competing priorities
  • Ability to navigate and problem-solve in a cross-matrixed environment
  • Proficiency with MS Office Suite and willingness to learn other platforms, as required
  • This is 100% remote in all states except for CA - except for quarterly meetings in house

Responsibilities

  • Serve as a point of contact between the Enterprise and designated payors, acting in an “account manager” role with payors. Work with payors to resolve issues, build cooperative relationships, and track and monitor changes to payor policies and procedures. Participate in payor meetings, including setting agendas, documenting key takeaways and next steps, and following up on outstanding items.
  • Work with internal teams to proactively identify trends and resolve recurring reimbursement or operational/admin issues. Escalate issues with significant impact to management, after initial efforts to reach a suitable resolution have failed or are of such magnitude that they warrant immediate management intervention.
  • Synthesize and communicate payor policies and guidance to internal teams on payor-related matters, including changes to coding, billing, and admin reimbursement processes
  • Work with the Director of Operations, Payor Relations, identifies operational and financial opportunities and concerns for the Enterprise related to changes to payor coding, healthcare payment and administrative policy, and regulatory matters. Work with internal departments to build an advocacy case to review with payors
  • Develop training tools to assist internal stakeholders with analyzing and implementing payor protocols.
  • Assist with escalations impacting patient care or access. Communicate with payors on the details of the patient case and works with internal and external teams to resolve barriers to care
  • Develop project plans and timelines for special initiatives to ensure timely execution and organizational objectives are met

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Mission & Purpose

Boston Children's Hospital is a 404-bed comprehensive center for pediatric health care. As one of the largest pediatric medical centers in the United States, Boston Children's offers a complete range of health care services for children from birth through 21 years of age. (Our services can begin interventions at 15 weeks gestation and in some situations we also treat adults.) We have approximately 25,000 inpatient admissions each year and our 200+ specialized clinical programs schedule 557,000 visits annually. Last year, the hospital performed more than 26,500 surgical procedures and 214,000 radiological examinations. Our team of physicians and nurses has been recognized by a number of independent organizations for overall excellence, and we're proud to share some notable examples with you here.