Payer Relations Specialist – Uwmedicine

Overview

Job Description

UWMEDICINE CONTRACTING & PAYER RELATIONS has an outstanding opportunity for a PAYER RELATIONS SPECIALIST
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• Full-Time – 100% FTE
• Hybrid Schedule

• Support payer relations operations through research, analysis, and coordination of managed care contracting activities.
• Assist with drafting, reviewing, and maintaining contract documents and credentialing applications to ensure accuracy and compliance.
• Contribute to negotiations, issue resolution, appeals, and single‑case contract development through policy research, document preparation, and stakeholder communication.

The PAYER RELATIONS SPECIALIST provides support in the efforts of the Payer Relations Program of the UW Medicine’s Contracting & Payer Relations Department in the managed care/health insurance contracting process, including assistance in negotiations of large and small scale managed care agreements, assistance in drafting and review of contract language, maintenance of online and physical contract files, research of payer policies and healthcare regulations and laws, assistance in resolution of contract-related issues, completion of annual facility/payer credentialing applications, and other contracting-related tasks as applicable.

• Conduct research, communications, and analysis to appropriately respond to or evaluate issues raised by Contracting staff or internal/external stakeholders and develop/facilitate responses
• Assist in oversight of contract document control process to assure that contract documents are executed and filed in an accurate, consistent, and efficient manner, and filed/maintained in compliance with all applicable laws, regulations, and UW Medicine policies
• Complete annual payer credentialing applications and forms for facilities, including communication with payers and internal stakeholders as necessary
• Ensure that annual facility credentialing (including re-credentialing) applications and forms are accurately submitted within the timelines required by contracted managed payers
• Maintain accurate and consistent records of submitted credentialing applications and forms, payer responses and communications related to applications and forms, and all other relevant documents
• Assist in negotiations with contracted managed care payers to secure favorable contract terms, including reimbursement rates, key contract language, and issue resolution
• Assist in protests and/or appeals of adverse hospital and/or professional services claims decisions by payers, including research of relevant case facts, contracts, payer policies, or regulations, drafting of protest/appeal letters, and communications with UW Medicine and payer staff
• Organize, oversee, attend, and/or participate in periodic payer operations meetings in collaboration with the Director of Provider Relations
• Track issues and resolutions to issues to possibly address in subsequent contract negotiation processes
• Communicate with contracted payer and UW Medicine staff members as is required to accomplish the day to day duties and functions of the Contracting & Payer Relations Department
• Negotiate and draft single case contracts with government and commercial managed care payers to accurately reflect all relevant agreement details, including but not limited to reimbursement terms, payment deadlines, and risk mitigation terms
• Maintain information and data related to single case contracts and provide regular reporting regarding single case contract volumes, related charges and reimbursement, and other key information
• Draft and review managed care contract language as required to accomplish day to day duties and functions of the Contracting & Payer Relations Department

• Bachelor’s Degree in Business, Health Administration, Nursing or other related fields
• A minimum of two to three years experience in care/health insurance contracting and negotiations, healthcare provider reimbursement, health insurance payer/provider relations, and/or healthcare payer policies/processes
• Equivalent education and/or experience may substitute for minimum qualifications except when there are legal…