Diversity, Equity, and Inclusion Program Manager, Senior - Remote
Prime Therapeutics
Payer Relations Analyst
Indiana Hemophilia & Thrombosis Center, Inc.
full-time
Posted on:
Origin: • 🇺🇸 United States
Visit company websiteJob Level
Mid-LevelSenior
About the role
- Provide oversight of all credentialing workflows, including re-credentialing and privileging processes, to ensure efficiency, accuracy, and compliance for applicable medical staff in both primary and secondary roles.
- Contract analysis and support: Conduct independent, detailed reviews of payer contracts and recommend changes to improve reimbursement terms; Monitor contract performance and identify discrepancies or underpayments; Support negotiation efforts by evaluating financial models and presenting findings with actionable recommendations to leadership. Partner with management to propose negotiation strategies and assess potential business risk.
- Data analysis and reporting: Interpret complex data sets with the goal to identify trends in denials, reimbursement rates, and payer behavior; Develop and maintain dashboards and reports for internal stakeholders. Providing recommendations to leadership that influence operational and financial decisions; Provide insights to improve payer performance and revenue cycle efficiency.
- Relationship management: Help resolve issues related to claims, payments, and contract terms; Track and document payer communications and outcomes.
- Compliance and policy monitoring: Stay informed on changes in payer policies, government regulations, and reimbursement guidelines; Ensure organizational practices align with payer requirements and industry standards.
Requirements
- 5 years of credentialing experience preferred
- GED or High School diploma required. College degree preferred.
- Valid driver's license and automobile insurance is required.
- All IHI employees are expected to enable multi-factor authentication via their personal smart phone/smart device in order to access IHI systems as a requirement of the role.
