Payor Relations Specialist

SHIFT:

Day (United States of America)

Children’s Hospital of Philadelphia (CHOP) offers countless ways to change lives. Our diverse community of more than 20,000 Breakthrough Makers will inspire you to pursue passions, develop expertise, and drive innovation.

At CHOP, your experience is valued; your voice is heard; and your contributions make a difference for patients and families. Join us as we build on our promise to advance pediatric care-and your career.

CHOP does not discriminate on the basis of race, color, sex, national origin, religion, or any other legally protected categories in any employment, training, or vendor decisions or programs. CHOP recognizes the critical importance of a workforce rich in varied backgrounds and experiences and engages in ongoing efforts to achieve that through equally varied and non-discriminatory means.

At the Children’s Hospital of Philadelphia Practice Association (CHOPPA), we believe in making a meaningful impact-together. We’re looking for a collaborative and detail-oriented Payor Relations Specialist to join our dedicated Reimbursement Strategy and Contracting team.

In this role, you’ll help ensure that our health system’s payor contracts are fully understood and followed, working to strengthen revenue streams and reduce administrative roadblocks. Your efforts will directly support CHOP’s goal of helping our teams focus on what matters most: delivering exceptional care to children and families.

You’ll work closely with leaders across departments and divisions to identify and address managed care challenges, stepping in when issues need to be escalated with payors. If you're passionate about problem-solving, relationship-building, and contributing to a purpose-driven team, we’d love to meet you.

This hybrid role requires on-site attendance one day a week (Tuesday or Thursday) during regular Monday-Friday day shift hours, with additional in-office presence for special meetings as needed.

• The Payor Relations Specialist supports the enterprise by being the source of information related to payor contracts, payor policies and guidelines, new plan information (market intel) and other relevant information related to the payor market.
  
• Serves as the primary point of contact with payors for contractual rate changes for the PFS-P to the Manager of Revenue Analytics.
  
• Provides contract interpretation support and education for the health system.
  
• Prospectively identifies operational and financial opportunities for the health system specific to a new payor agreement.
  
• Organizes and leads contract implementation process with completion of new agreements and contract terminations.
  
• In partnership with the Reimbursement Strategy and Contracting leaders, is an active participant in analyzing new and renewal contracts with the payor
  
• Works closely with Access and Revenue Cycle teams to identify and remove or reduce access and revenue cycle barriers.
  
• Tracks and prepares business perspectives of contracts for Legal review. Supports other contract negotiations as required.
  
• Provides monthly updates of payor policies and procedures within the health system.
  
• Interacts with all individuals in the organization in a professional and customer-focused manner.
  

• Bachelor's Degree
  

• At least seven (7) years industry and topical related experience
  

• Must possess strong understanding of the local managed care environment, including, but not limited to, managed care policies and procedures, payment models and managed care models.
  
• Ability to interpret complex and comprehensive managed care information.
  
• Excellent communication skills (including oral and written presentation), demonstrated organizational skills, ability to multi-task.
  
• Strong interpersonal skills.
  
• Ability to work independently, achieves specific goals and objectives, and provides recommendations for improvement.
  
• Ability to work collaboratively with a strong orientation for bottom line results.
  
• Strong working knowledge of key computer applications such as EPIC and Microsoft Office suite of products.
  
• Ability to work with large set of diverse data with the ability to summarize in to meaningful presentable and actionable information
  

$74,250.00 - $94,660.00 Annually

Salary ranges are shown for full-time jobs. If you're working part-time, your pay will be adjusted accordingly.

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At CHOP, we are committed to fair and transparent pay practices. Factors such as skills and experience could result in an offer above the salary range noted in this job posting. Click here for more information regarding CHOP's Compensation and Benefits.