Payor Specialist - Contract Management Support - Southwestern Health Resources

Payor Specialist - Contract Management Support - Southwestern Health Resources

Southwestern Health Resources is looking for a highly skilled Payor Analyst .

Is that you?

Work Location: Remote: Southwestern Health Resources Headquarters, Hybrid: 1601 Lyndon B.

Johnson Freeway, Farmers Branch, TX 75234.

Work Hours: Full Time Days (8:00am-5:00pm) for 40 hrs/week (remote work allowed at manager's discretion)

Onsite Requirement: 2 Days a week

Department Highlights:


* Hybrid Position


* Gain a sense of accomplishment by contributing to a teamwork environment.


* Receive excellent mentorship, comprehensive training, and dedicated leadership resources.


* Contribute and work on a cross functional team

What You Will Do:

Contract Management Support:
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Review and interpret payor contracts to understand contract language, financial incentives, and other relevant items of the contract.
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Assist with maintaining contract language key terms by payor tracking grid.
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Prepare routing documents for new contracts and amendments.
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Review and redline low-level amendments (e.g., term extensions, quality measure updates) and exhibits
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Complete and distribute new contract orientation forms and communications to internal stakeholders.
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Maintain organized records of contract status, amendments, and stakeholder communications.
30%
Project Management:
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Maintain project tracker by payor (e.g., Aetna, BCBSTX, Cigna, UHC) and monitor project status.
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Participate in payor calls, identify trends, work with payors to resolve issues and document outcomes.
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Escalate unresolved issues to appropriate parties and follow through to resolution.
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Maintain and update project trackers, ensuring alignment with internal stakeholders and timelines.

30%
Contract Operations - New Contracts and Amendments
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Interpret and communicate contract or contract changes to internal stakeholders.
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Collaborate with analysts to assess the financial implications of a new contract or contract amendments for internal stakeholders.
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Notify payors of significant impacts within required timeframes and monitor resolution status.
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Document and communicate new contract and contract changes and outcomes to relevant internal teams.

10%
Managed Care Projects & Provider/Payor Queries
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Support cross-functional managed care initiatives and respond to provider or payor-related queries.
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Communicate with providers, payors, internal stakeholders (quality, medical economics, finance), and others to resolve issues and improve processes.
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Collect, organize, and present data in a clear and actionable format.
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Provide timely updates and final reports to requesting departments or leadership.
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Ensure all project documentation is complete, accurate, and accessible.

20%
Committee Participation
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Represent the Market and Payor Relations team in internal and external meetings, committees, and workgroups.
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Actively participate in discussions, share insights, and contribute to strategic plann...