Note: The job is a remote job and is open to candidates in USA. DaVita Kidney Care, through LAB Total Renal Laboratories, Inc., provides clinical laboratory services and manages payer relationships for healthcare reimbursement. The Administrator, Payer Partnerships (Lab) administers payer contracts, maintains in-network status, supports credentialing and negotiations, ensures compliant billing, and coordinates contract implementation and analytics.
Responsibilities
- Complete and monitor provider credentialing applications, negotiate payer contracts and single patient agreements on behalf of the lab
- Process payer correspondences and complete monitoring of rules and regulations from Governmental entities with the use of MediRegs and various sources
- Read and interpret new, amended, renegotiated payer contracts and single patient agreements in preparation for system implementation
- Coordinate with Lab Finance Systems and Lab Billing to setup payers in the billing system
- Coordinates with Lab ROPS and DKC Payor Partnerships teammates as needed to resolve contract issues
- Analyze fee schedule changes for loading into the system
- Address and resolve interface deficiencies
- Perform payer analytics and identify trends through root cause analysis including review of newly established contracts to ensure accuracy in billing and reimbursement
- Provide recommendations and redlines to Payor Partnerships (DKC) for lab terms within proposed contracts
- Coordinate with Payor Partnerships (DKC) to trouble shoot problematic payers, address contractual discrepancies, language impact, and perform necessary financial impact analytics
- Add facilities and products to existing contracts and terminate from existing contracts
Skills
- Legal language
- Contract Interpretation
- Contract Negotiation
- Credentialing
- Knowledge of provider and payer relationship
- Knowledge of Revenue Operations in Health Care
- Knowledge of rules and regulations around Government entities such as CMS
- Intermediate computer skills and proficiency in MS Word, Excel, Outlook, and ability to use Internet effectively required
Benefits
- Hybrid work arrangement
- Comprehensive benefits: Medical, dental, vision, 401(k) match, paid time off, PTO cash out
- Family resources
- EAP counseling sessions
- Access to Headspace®
- Backup child and elder care
- Maternity/paternity leave
- Professional development programs to help strong performers grow within their career
- On-demand virtual leadership and development courses through DaVita’s online training platform Star Learning
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