The Payer Relations & Contracting Specialist holds a pivotal role in fostering positive relationships with healthcare payers and managing effective contracts to ensure fair and timely reimbursement for our hospice companys compassionate end-of-life care services. This multifaceted position requires adept communication, negotiation skills, and collaboration with payers, as well as a commitment to advocating for reimbursement terms that align with our mission and uphold the financial stability of the organization.
Must be able to work on-site at the Corporate Miramar, Florida office, Monday through Friday 8am- 5pm. Hybrid schedule. All duties and responsibilities are to be performed in accordance with VITAS Healthcare Corporation's policies, procedures, guidelines, contractual commitments, and governmental regulations.
Job Responsibilities:
Contract Management: • Draft, review, and negotiate contracts with healthcare payers, hospice service providers, and other partners. • Ensure that contracts align with the organizations strategic goals and comply with all legal and regulatory requirements.
Contract Review: • Conduct detailed reviews of contract terms, payment rates, and performance metrics to identify areas for negotiation and improvement. • Collaborate with the Payer Relations & Contracting Manager and legal counsel to address contract-related issues.
Payer Relations: • Assist in maintaining positive relationships with healthcare payers and partners. • Work with the Payer Relations team to advocate for favorable reimbursement rates and terms.
Compliance and Documentation: • Ensure that all contracts and agreements are accurately documented and stored in accordance with company policies. • Monitor compliance with contractual obligations, regulations, and accreditation standards.
Cross-Functional Collaboration: • Collaborate with various departments, including Payer Relations, Revenue Cycle, Finance, Operations, and Legal, to support the organizations financial and operational goals.
Performance Metrics: • Track and report on contract performance, including revenue and reimbursement data. • Work with Payer Relations Specialist to provide regular updates to management on the status of contracts and payer relationships. • Stay informed about changes in the healthcare industry, payer policies, and regulations affecting hospice care.
Payer Relationship Management: • Cultivate and maintain strong working relationships with healthcare payers, including insurance companies, government programs (Medicare and Medicaid), hospice associations, and other third-party payers. • Serve as the primary point of contact for both internal and external partners at the health plans, state, and hospice associations.
Communication and Collaboration: • Facilitate regular communication with payers to address inquiries, resolve issues, and negotiate favorable terms. • Collaborate with internal departments, including Contracting, Credentialing, Revenue Cycle, Operations, Finance, and Quality Assurance, to support effective payer relations. • Assist PR&C Manager collaborations with state and hospice association.
Contract Advocacy: • Work with the Contract Specialist to advocate for favorable contract terms and reimbursement rates during contract negotiation processes. • Monitor the impact of contract terms on reimbursement and report findings to the Payer Relations & Contracting Manager.
Claims and Reimbursement: • Monitor and track the status of claims escalations, ensuring timely and accurate reimbursement from payers. • Collaborate with the PR&C Manager and Revenue Cycle team to address payment discrepancies or denials and identify trends. • Assist the PR&C Manager with the preparation of reports on payer performance and trends for internal stakeholders. • Provide insights and recommendations for process improvements in payer relations and reimbursement optimization.
Compliance and Regulatory Adherence: • Ensure that all interactions with payers comply with regulatory requirements and industry standards. • Stay informed and report back changes in payer/state policies, regulations, and reimbursement models to ensure compliance.
Continuous Improvement: • Proactively identify opportunities to enhance the departments efficiency and effectiveness to report back to the PR&C Manager. • Recommend and implement process improvements to enhance contract management and negotiation processes.
Qualifications:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.
Experience:
• Minimum of 3 years of experience in contract management, preferably in a healthcare or hospice setting. • Strong understanding of healthcare payer systems, reimbursement models, and insurance policies. • Excellent negotiation and communication skills. • Exceptional relationship-building skills. • Detail-oriented with strong analytical abilities. • Ability to analyze data and make data-driven decisions. • Knowledge of healthcare regulations and compliance standards. • Proficiency in contract management software and Microsoft Office Suite. • Ability to work both independently and as part of a team. • Strong problem-solving skills and the ability to adapt to changing industry dynamics.
Education:
Bachelors degree in business, healthcare administration, or a related field preferred.
Certification & Licensure:
None required for this position.
Physical Requirements:
Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions of the job.
About VITAS Healthcare:
VITAS Healthcare is the nation's leading provider of end-of-life care, and has the resources and expertise to support your personal and professional growth. As a member of the VITAS team, you'll find fulfillment working for a people-focused organization dedicated to making a difference in the lives of others. You will be more than just an employee: You will be counted on as an expert in your field, and as a valued team member whose efforts are respected and vital to our hospice mission.
Benefits:
Many of our positions offer the opportunity to work day or night shifts, weekdays or weekends. Choose a Career with VITAS.
VITAS Healthcare®, a pioneer and leader in the hospice movement since 1978, is the nation’s largest provider of end-of-life care. Our name is derived from the Latin word for “lives” and symbolizes the VITAS mission: to preserve the quality of life for those who have a limited time to live.
Headquartered in Miami, Florida, VITAS operates hospice programs in 15 states and the District of Columbia. VITAS has enjoyed dynamic growth since its founding as a volunteer organization by a United Methodist minister and an oncology nurse. Today, VITAS employs 11,773 professionals who care for terminally ill patients daily-primarily in the patients’ homes, and also in the company’s inpatient hospice units as well as in hospitals, nursing homes and assisted living communities/residential care facilities. VITAS team members include registered nurses, licensed practical nurses, home health aides, physicians, social workers, chaplains and other caregiving professionals.