Contracting and Payor Relations Specialist
The primary purpose of this job is to manage payor relations between Lynn Community Health, Inc and insurance companies. This individual will review contracts, conduct analysis, negotiation, implementation, payer relations, and payor credentialing for the health center.
Responsibilities:
- Identifies, analyzes, and manages payor projects, as assigned, such as auditing contract provisions, completing credentialing requests, interdepartmental work groups, negotiations and maintenance of payor contracts and legal files.
- Understands legal terms and concepts related to contracting; Must be able to research state and federal laws and statute and interpret their meaning and use in Managed Care contracts.
- Negotiates Single Case Agreements with Payers as may be required.
- Own the credentialing process for each payor and submit all relevant information timely.
Qualifications:
- Minimum Education: HS Diploma or equivalent Required
- 2-3 years of experience.
Minimum Work Experience
- Previous experience in health care business office, contracting or payer organization Required
Skills Required
- HS Diploma or equivalent
- 2-3 years of experience in health care business, contracting, or payer organization
What We Do
Lynn Community Health Center is the largest provider of primary care, behavioral health, eye care, and dental services in one of the most medically underserved communities in Massachusetts. Established in 1971 as a small storefront mental health clinic, we now have more than 550 employees at multiple sites throughout the City of Lynn. We serve more than 46,000 individuals annually—40% of all Lynn residents and children under 18. Our mission is to provide comprehensive health care for everyone in our diverse community, regardless of ability to pay. Our target populations are those with the greatest barriers to care: the poor, minorities, non-English speaking, children, teens and the frail elderly. A significant percentage of our patients have behavioral health needs. To best achieve our mission, we have developed an innovative model of Integrated Care in which primary care and behavioral health providers practice together as a team, co-managing patient care. This has significantly improved access and reduced stigma for those in need of behavioral health care. Our teams are distinguished by a fierce dedication to empowering disenfranchised communities. It is an incredible learning environment for every employee, in which there exist opportunities for both providing and receiving mentoring and coaching, participating in innovative pilot projects, and the satisfaction of a job well done.
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