Payer Relations Associate
Billings Clinic

Billings, Montana

This job has expired.


You'll want to join Billings Clinic for our outstanding quality of care, exciting environment, interesting cases from a vast geography, advanced technology and educational opportunities. We are in the top 1% of hospitals internationally for receiving Magnet® Recognition consecutively since 2006.

And you'll want to stay at Billings Clinic for the amazing teamwork, caring atmosphere, and a culture that values kindness, safety and courage. This is an incredible place to learn and grow. Billings, Montana, is a friendly, college community in the Rocky Mountains with great schools and abundant family activities. Amazing outdoor recreation is just minutes from home. Four seasons of sunshine!

You can make a difference here.

About Us
Billings Clinic is a community-owned, not-for-profit, Physician-led health system based in Billings with more than 4,700 employees, including over 550 physicians and non-physician providers. Our integrated organization consists of a multi-specialty group practice and a 304-bed hospital. Learn more about Billings Clinic (our organization, history, mission, leadership and regional locations) and how we are recognized nationally for our exceptional quality.

Your Benefits
We provide a comprehensive and competitive benefits package to all full-time employees (minimum of 24 hours/week), including Medical, Dental, Vision, 403(b) Retirement Plan with employer matching, Defined Contribution Pension Plan, Paid Time Off, employee wellness program, and much more. Click here for more information or download the 2021 Employee Benefits Guide.

Magnet: Commitment to Nursing Excellence
Billings Clinic is proud to be recognized for nursing excellence as a Magnet®-designated organization, joining only 97 other organizations worldwide that have achieved this honor four times. The re-designation process happens every four years.  Click here to learn more!

Payer Relations Associate
PAYER RELATIONS (Billings Clinic Main Campus)
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Shift:  Day
Employment Status:  Full-Time (.75 or greater)
Hours per Pay Period:  1.00 = 80 hours (Exempt)
Starting Wage DOE:  $39.00 - $46.80

The Payer Relations Associate is responsible for internal and external coordination of payer contracting and support activities including leading the contract evaluation process, negotiation, research, analysis, implementation, communications, and ongoing maintenance for all Billings Clinic-owned facility and professional service lines. Responsible for maintaining major relationships with insurers, payers, employers, health trusts, third party administrators, and government contractors. Supervises provider enrollment and payer compliance functions and staff.

Essential Job Functions

* Leads and coordinates payer contract evaluation process including language and reimbursement review and negotiation, contract modeling, complex analysis, implementation, communication, and ongoing contract maintenance with information provided by Billings Clinic staff and outside parties including fee-for-service, value-based and risk contracting.
* Responsible for maintaining major relationships with insurers, payers, employers, health trusts, third party administrators, and government contractors.
* Supervises provider enrollment and payer compliance functions and staff.
* Coordinates communication and problem resolution between Billings Clinic revenue cycle (billing, coding, patient access, utilization management, care management and population health) and insurers, payers, employers, health trusts, third party administrators and government contractors.
* Assists administration in the coordination of payer relations operations in support of achieving the overall vision and strategic goals of Billings Clinic. Works closely with all levels of Billings Clinic administration and management ensuring an understanding of the issues and programs of work needed and payer issue resolution.
* Researches national, regional, and local market payer trends and issues and determines the potential impact to Billings Clinic payer relations operations.
* Researches national and state legislation and regulations in support of the Billings Clinic Health Policy priorities. Represents Payers Relations on the Government Affairs Committee.
* Responsible for management and oversight of Certified Application Counselor CMS designation and oversight and implementation of federal and state requirements for Certified Application Counselors.
* Assures expert understanding and compliance with regulatory requirements under state and federal laws related to payers and insurance.
* Maintains key records, reference materials and data for the orderly conduct of business.
* Utilizes performance improvement principles to assess and improve quality.
* Identifies needs and sets goals for own growth and development; meets all mandatory organizational and departmental requirements.
* Maintains competency in all organizational, departmental, and outside agency environmental, employee or patient safety standards relevant to job performance. Ensures staff compliance with the same.
* Performs other duties as assigned or needed to meet the needs of the department/organization.
* Supports and models behaviors consistent with the mission and philosophy of Billings Clinic and department/service.
* Provides leadership, supervision, and oversight of assigned staff. Performs the functions of interviewing, hiring, scheduling, establishing priorities and assigning workloads, orientation/training, performance appraisals, coaching/counseling, disciplinary up to and including discharge as coordinated with the Director and Human Resources. Responsible for adhering to established human resource management policies and procedures.
* Participates in the development of and assists with implementation of an education plan that addresses individual and departmental needs. Conducts regular staff meetings and directs the orientation and training of new staff and provides ongoing education to staff. Creates an environment in which personnel can realize personal growth and development through active participation in departmental decisions, opportunities for professional growth and consistent application of personnel policies.
* Assists Director with the development, implementation and maintenance of departmental policies, procedures, and practices.

Knowledge, Skills, and Abilities

* Billings Clinic policy and procedures, both organizational and departmental
* Billings Clinic Corporate Compliance Program
* Billings Clinic Code of Business Conduct
* Customer service techniques and Personal Service Excellence (PSE) skills
* Personal computers, hardware and software
* HIPAA and confidentiality requirements
* Patient's/resident's rights
* Payer relations products and business theory related to this area
* Health systems business office and support departments' operations: physician, hospital and ancillary services
* Insurance operations and disciplines related to contracting and analysis
* Knowledge of coding, billing, quality measure and utilization measure concepts and terms
* Leadership principles and practices
* Application leadership principles and practices
* Negotiations
* Contracting across all health care disciplines
* Complex data analysis, contract modeling and critical thinking
* Analyzing and developing complex facility and professional reimbursement methodologies
* Payer contract language review
* Professional communication skills, both verbal and written
* Personal computer operation and word processing and spreadsheet development and maintenance
* Research processes and source locations
* Organization, prioritization, and time management
* Identification and resolution of problems
* Working with technical staff across departmental lines at all levels
* Leading peers and management through contract evaluations
* Incorporate population specific needs into all aspects of communication and patient care; scope of services provided will encompass age groups from infant through geriatric
* Communicate clearly and effectively, both verbal and written within and outside of Billings Clinic
* Establish and maintain collaborative relationships
* Work independently
* Monitor, compile, and analyze information
* The nature of output generated by this position has far reaching impact to the current and future position of Billings Clinic. Therefore, the accuracy and integrity of the information provided is critical.
* Completes assignments of a broad nature while exercising considerable independent judgment and originality.
* Makes decisions regarding human resource management and policies which may have legal implications

Minimum Qualifications
Education
-Bachelors degree in business or appropriate health care field
Experience
-Five (5) years of experience in a progressively challenging environment of coordinating activities and information from internal departments and external parties preferably in a large health care organization relating to contract and negotiation skills
-Demonstrate career success in a maturing managed care marketplace

Or an equivalent combination of education and experience relating to the above tasks, knowledge, skills and abilities will be considered

 Billings Clinic is Montana's largest health system serving Montana, Wyoming and the western Dakotas. A not-for-profit organization led by a physician CEO, the health system is governed by a board of community members, nurses and physicians. Billings Clinic includes an integrated multi-specialty group practice, tertiary care hospital and trauma center, based in Billings, Montana. Learn more at www.billingsclinic.com/aboutus

Billings Clinic is committed to the principles of Equal Employment Opportunity. All policies and processes are designed toward achieving fair and equitable treatment of all employees and job applicants. Employees are encouraged to discuss any concerns they have in this regard with their immediate supervisor and/or the Vice President People Resources. All employees and job applicants will be provided the same treatment in all aspects of the employment relationship, regardless of race, color, creed, religion, national origin, gender, gender identity, sexual orientation, age, marital status, genetic information or disability.


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