Job Synopsis
HealthRecon Connect LLC provides technology-enabled Revenue Cycle Management solutions to US healthcare providers. We leverage over 30 years of deep domain expertise, cutting-edge analytics as well as machine learning, Artificial Intelligence and Automated workflows to help improve cashflow, patient outcomes and enable peace of mind for our clients.
Location: Any State
Employment Type: 1099 Consultant
Overview:
We are seeking a highly experienced Insurance Payor Credentialing & Contracting Expert with specialized knowledge in the California market. They will be primarily responsible for the negotiation, implementation and oversight of payor contracts and relationships. The position will work closely with the credentialing team operations to troubleshoot contract issues and assist where necessary to bring them to resolution using their understanding of the underlying contracts as well as by leveraging their payor relationships. The ideal candidate will have a proven track record of negotiating and managing Commercial payor contracts, specifically for Emergency Departments and Hospital Medicine Providers. As a 1099 consultant, you will play a crucial role in ensuring that our organization optimizes reimbursement rates, maintains compliance with payor requirements, and establishes strong partnerships with insurance providers.
Responsibilities:
- Contract Negotiation:
- Lead negotiations with Commercial payors, focusing on Emergency Departments and Hospital Medicine Providers, ensuring financial and strategic goals are translated into contractual language accordingly.
- Analyze and evaluate proposed contract terms, reimbursement rates, and other key elements to secure favourable agreements.
- Serves as the expert on all terms of the payer contract for both internal and external parties
- Market Analysis:
- Conduct thorough research on the California healthcare market, identifying trends, competitors, and opportunities for contract optimization.
- Collaborate with internal stakeholders to align contract strategies with organizational goals.
- Relationship Management:
- Cultivate strong relationships with payor representatives, fostering open communication and collaboration.
- Address and resolve any issues related to contract performance, payment discrepancies, or credentialing concerns.
- Compliance:
- Ensure compliance with regulatory requirements and payor policies, proactively identifying and addressing potential risks.
- Stay informed about changes in healthcare regulations and reimbursement policies affecting the California market.
- Documentation and Reporting:
- Maintain accurate records of contracts, negotiations, and credentialing activities.
- Generate reports on contract performance, reimbursement rates, and other key metrics.
Requirements:
- Proven experience (5+ years) in payor contracting specifically in the California healthcare market, knowledge of hospital operations, health/insurance benefit plans, revenue cycle claims systems and complex reimbursement methodologies.
- Possesses key payor contacts and maintains ongoing relationship with provider representatives.
- Excellent negotiation skills with a successful track record of securing favourable payor contracts.
- In-depth knowledge of Emergency Department and Hospital Medicine billing and reimbursement practice (required)
- Familiarity with California-specific healthcare regulations and credentialing requirements.
- Excellent communication and interpersonal skills to build and maintain effective relationships with payor representatives and internal stakeholders.
- Detail-oriented with strong organizational and analytical abilities.
- Ability to work independently as a 1099 consultant and meet deadlines.
If you possess the required experience and skills, we invite you to apply for this exciting opportunity to contribute to our organization's success in the dynamic California healthcare landscape.
Job Type: Contract
Pay: $24.00 - $26.00 per hour
Expected hours: 20 – 30 per week
Benefits:
- Flexible spending account
Schedule:
Experience:
- payor contracting: 7 years (Preferred)
Work Location: Remote