This employee reviews payor contracts and information associated to contractual obligations including payor fee schedule changes and posted policy updates for various payors. They will work with Managed Care Contract Administrators, Payor and Price Table Team, and other required departments to ensure that policy guidelines and changes are updated accordingly and timely.
JOB FUNCTIONS Contacts payors at times to discuss policies and/or changes Documents payor requirements according to their policies as well as payor changes and relays changes to the appropriate departments Pursues, maintains, and communicates medical guideline changes Helps facilitate interoffice communication on payor updates and changes Works with the Payor and Price Table team to ensure that policy changes are updated accordingly Works assigned payors accordingly and timely Available to assist other members on the team with questions and/or needs Answers payor policy questions accordingly Assists in identifying payor changes that need to be addressed Works with BIS, payor, and price table group to ensure that payor policies are followed and updated accordingly to payor guidelines once changes have been identified Communicates with the payor regarding policy information Assists with the delivery directives from Corporate office as they apply to policy changes and/or updates