St. Charles Health System
Billing Informatics Specialist (Full Time Variable) jobs are vacant in Bend,OR. The St. Charles Health System it's specialized into Accounting & Finance industry. Currently the headquarters are in Oregon.
Billing Informatics Specialist (Full Time Variable) job positions are vacant on St. Charles Health System company, located in Bend with a rate of $23-40/hour.
More details about the job listing:
Typical pay range: 31.09 42.93
ST. CHARLES HEALTH SYSTEM
TITLE: Payer Relations Contracting Specialist
REPORTS TO POSITION: Director Payer Contracting and Health Plan Administration
DEPARTMENT: Health Plan Administration
DATE LAST REVIEWED: April 22 2020
OUR VISION: Creating America s healthiest community together
OUR MISSION: In the spirit of love and compassion better health better care better value
OUR VALUES: Accountability Caring and Teamwork
DEPARTMENTAL SUMMARY: The Health Plan Administration Department at St. Charles Health System SCHS is responsible for the following in our multi hospital organization: all payer relations and contracting developing and implementing new payment models to further St. Charles strategic intent to move from fee for service to value monitoring of payer performance oversight and management of payer related quality and performance metrics.
POSITION OVERVIEW: The Payer Relations Contracting Specialist at SCHS provides key functional and operational support in St. Charles journey from fee for service to value based contracting. This position plays a critical support role to the Director of Payer Contracting and Health Plan Administration and other SCHS leadership to enhance the operation and financial performance of the system that will yield a sustainable revenue model. The primary responsibility of this position is to assist with payer contract negotiations engage in population health and network initiatives promote positive payer relations facilitate payer issue resolution and support payer contract analytics and modeling.
This position does not directly manage other caregivers however will be required to work with and collaborate with other caregivers throughout the enterprise.
ESSENTIAL FUNCTIONS AND DUTIES:
In partnership with Director Payer Contracting and Health Plan Administration develops analyzes implements and monitors implementation of fee for service shared savings capitation and other value based contracting models that support St. Charles hospital medical group and ancillary services revenue management and strategic revenue model transition.
Responsible for the technical understanding of sophisticated contracting methodologies including Advanced Payment Models APMs .
Establishes acceptable contract language and payment terms for hospital medical group ancillary services and behavioral health contracts to support St. Charles revenue management and transition towards value based care model redesign.
Assists with the reimbursement modeling using Strata payer modeling to support product line development analysis projects charge master changes contract amendments payment disputes provider manual changes and value based contract scenarios.
Monitors and reconciles payer contract quality and financial performance renewals and provisions for appropriate re negotiation action planning and notification of internal and external stakeholders.
Develops best practice policies and procedures work guides or tools to provide improved department and enterprise training and process workflows.
Facilitates clinical operational and financial payer issues and or dispute resolution including the coordination of Joint Operations Committee meetings between affected internal and external stakeholders.
Identifies opportunities challenges and obstacles to payer contracting and provides appropriate recommendations for remediation or escalation.
Creates and generates ad hoc reports as needed.
Monitors healthcare market and legislative changes that may impact SCHS.
Assists credentialing department with initial or re credentialing payer issues.
Supports budget development monitoring accountability and meeting all operational goals and targets for all areas within the span of control.
Conducts all activities with the highest standards of professionalism and confidentiality. Complies with all applicable laws regulations policies and procedures supporting the organization s corporate integrity efforts by acting ethically and appropriately reporting known or suspected violations of applicable rules and cooperating fully with all organizational investigations and proceedings.
Delivers customer service and or patient care in a manner that promotes goodwill is timely efficient and accurate.
Supports the vision mission and values of the organization in all respects.
May perform additional duties of similar complexity within the organization as required or assigned.
Required: Bachelor s degree in Business Health Care Administration or related field with comparable experience equating to same skill set.
Preferred: Master s Degree in Business Related Field Health Administration.
LICENSURE CERTIFICATION REGISTRATION:
Required: Valid Oregon driver s license and ability to meet St. Charles Health System driving requirements. Ability to travel to business functions training meetings and all St. Charles Health System worksites.
Preferred: N A
Required: Minimum of five 5 years of experience in healthcare management and Managed Care Payer Contracting in a healthcare provider or payer setting. Experience in negotiating sophisticated Advanced Payment Models APMs managed care agreements related to physicians hospitals ancillary and behavioral health providers.
Preferred: N A
ADDITIONAL POSITION INFORMATION:
Intermediate to advanced proficiency in Microsoft applications Word Excel and Access Meditract database management and document preparation.
Ability to examine and address multiple payer issues including operational reimbursement regulatory and coding matters.
Ability to grasp complex concepts related to managed care contracting and health reform methodologies.
Ability to manage key stakeholder interests while managing conflicting priorities and business interests.
Ability to adapt to a dynamic project environment and manage multiple projects. Strong team working and collaborative skills.
Ability to work with interruptions and changing work priorities and under tight deadlines.
Skilled in handling potentially adversarial situations requiring resolution ability to build and maintain a high level of trust and consensus over complex issues.
Strong negotiation analytical problem solving and decision making skills.
Excellent organizational and multi tasking skills. Strong attention to detail.
Excellent communication skills and ability to interact with a diverse population and professionally represent St. Charles Health System.
PERSONAL PROTECTIVE EQUIPMENT:
Must be able to wear appropriate Personal Protective Equipment PPE required to perform the job safely.
PHYSICAL REQUIREMENTS: Office Level 2
Continually 75 or more : Sitting keyboard operation use of clear and audible speaking voice and the ability to hear normal speech level.
Frequently 50 : Standing lifting 1 10 pounds grasping squeezing.
Occasionally 25 : Bending reaching overhead carrying pushing or pulling 1 10 pounds.
Rarely 10 : Walking stooping kneeling crouching climbing stairs.
Never 0 : Climbing ladder step stool lifting carrying pushing or pulling 11 50 pounds operation of a motor vehicle ability to hear whispered speech level.
Exposure to Elemental Factors
Never 0 : Heat cold wet slippery area noise dust vibration chemical solution uneven surface.
Blood Borne Pathogen BBP Exposure Category
No Risk for Exposure to BBP
Schedule Weekly Hours:
First Shift United States of America
Is Exempt Position
SPECIALIST PATIENT FINANCIAL SERVICES
Scheduled Days of the Week:
Shift Start End Time:
0800 to 1700