Job Information
Children's Hospital Boston Payor Relations Specialist - Government Relations in Boston, Massachusetts
76141BRJob Posting Title:Payor Relations Specialist - Government RelationsDepartment:Child Advocacy-Government RelationsAutoReqId:76141BRStatus:Full-TimeStandard Hours per Week:40 Job Posting Category:External RelationsJob Posting Description:Under the general supervision of and reporting to the Director of Payor Relations, the Payor Relations Specialist serves as a point of contact between the Enterprise and designated payors, acting in an “account manager” role with payers to resolve issues, build cooperative relationships, and track and monitor payor behaviors and actions.
The Payor Relations Specialist will be responsible to:
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
To qualify, you must have:
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
Boston Children’s Hospital offers competitive compensation and unmatched benefits including flexible schedules, affordable health, vision and dental insurance, child care and student loan subsidies, generous levels of time off, 403(b) Retirement Savings plan, Pension, Tuition and certain License and Certification Reimbursement, cell phone plan discounts and discounted rates on T-passes. Experience the benefits of passion and teamwork.Office/Site Location:BostonRegular, Temporary, Per Diem:Regular Remote Eligibility :Full-Time Remote