Payer Relations Specialist in Oak Brook, IL at Athletico

Date Posted: 10/29/2019

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    Oak Brook, IL
  • Job Type:
  • Experience:
    At least 5 year(s)
  • Date Posted:
    10/29/2019

Job Description



Mission Statement and Core Values

Athletico’s sole purpose is to provide exceptional, progressive, and cost-effective fitness, performance and rehabilitative services through personalized care that emphasizes education and prevention of future injury.  This is accomplished through building on our core values of patient/client satisfaction, accountability, teamwork and continuous improvement, which are the foundation for our unique culture.

Position Summary

The Payer Relations Specialist, under the direction of the Director of Managed Care and Payer Contracting, will help source and negotiate new and renewal contracts for Athletico and its subsidiaries to help grow and expand the company’s business.  This role will be continually challenged to improve and maintain payer relations and payer satisfaction in an ever-changing reimbursement environment with the objective to clearly demonstrate the value, efficacy and cost effectiveness of Athletico’s services.  A keen interest and understanding of payer needs and perspectives is essential.



Responsibilities

Essential Duties and Responsibilities

  • Support and negotiate contract terms and provisions in a variety of different agreements and reimbursement models
  • Perform strong quantitative and qualitative analysis by market to determine whether the company should be in or out of network with a particular payer or payer class
  • Develop comprehensive knowledge of, and communicate to payers, the clinical services and specialties of each Athletico market segment and the value proposition for the payer
  • Maintain cooperative relationships with payers, influencers and other potential purchasers of health care to expand access to narrow networks, value based arrangements and other innovative and new relationship and reimbursement models
  • Develop the ability to mitigate risk by understanding population-specific drivers of utilization and cost under risk-based contracts and identify ways to influence these drivers
  • Communicate contract terms and summaries that provide sales, finance, and revenue cycle management staff with timely and relevant information for contract management and claims billing
  • Support and implement annual regional and global strategic plans for payer contracting and negotiation
  • Analyze individual market (Macro/Micro) dynamics to achieve the best price point by payer.
  • Under the supervision of the legal department, help interpret contracts to address questions or mediate disputes
  • The ability to secure and attend in-person meetings with key high level decision makers at the targeted health plans to demonstrate Athletico capabilities and value proposition 

Additional Duties and Responsibilities

  • Provide direction to the managed care contracting activities and responsibilities for commercial health plan contracting. Successfully negotiate contracts that meet budgetary requirements
  • Establish and support innovative provider relationships that promote new programs, expand market share and generate revenue growth


Qualifications

Education and Experience:  

  • Bachelor’s degree or at least 5 years of payer contracting experience in healthcare
  • Highly organized with the ability to drive results, manage projects, and execute strategies in a collaborative, team-oriented environment
  • The ability to multi-task, work independently and be self-motivated
  • Existing knowledge and experience contracting with private and government payers and the strong desire to learn more
  • Skilled at end to end contract negotiations
  • Experience and expertise in working effectively with other internal and external constituents

 

Essential Qualifications:   

  • Ability to consistently communicate a clear understanding of patients/clients expectations and adapt as appropriate to exceed their needs
  • Ability to focus attention on determining what can be done to make progress
  • Ability to develop personally and professionally
  • Ability to foster a sense of teamwork and cooperation while working with others
  • Ability to understand and determine priorities, effectively manage time and develop work plans in order to accomplish tasks and/or projects
  • Ability to motivate, develop, and mentor staff in order to optimize their performance
  • Ability to clearly organize and effectively convey information

Athletico provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.   This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.