Payor Manager:
Children's Healthcare of Atlanta

31489-en_US
Children's Healthcare of Atlanta
Atlanta Georgia
Healthcare
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Description

Work Schedule/Days:  Day / Monday - Friday
Employment Type:  Full-Time
Location:  Park North - Harvard 
Requisition #:  31489

 

JOB SUMMARY

The Payor Manager represents and advocates for Children's Healthcare of Atlanta business interests with external relationships with payors by negotiating and implementing managed care agreements (including renewals) for Children's Healthcare of Atlanta's owned, managed, or contracted facilities and professional services. Coordinates flow of managed care information to internal stakeholders, develops and implements contracting strategy to ensure continuous improvement, and proactively supports Children's Healthcare of Atlanta efforts to ensure the safe delivery of patient care and services.

EDUCATION

  • Bachelor’s degree in Business or health-related discipline, or equivalent experience

EXPERIENCE*

  • 3 years of experience in managed healthcare or related field
  • Experience in negotiation, contract drafting, and hospital and professional rate-setting and analysis

PREFERRED QUALIFICATIONS*

  • Master's or law degree

KNOWLEDGE SKILLS & ABILITIES*

  • Knowledge of medical office practices, managed care operations,  hospital admitting, billing, medical records, and utilization management as they relate to pediatric care
  • Ability to draft contract language that supports Children’s Healthcare of Atlanta's position and approved reimbursement methodologies
  • Ability to lead and interpret development efforts for payment methodologies, including quality programs or value-based reimbursement arrangements
  • Ability to work collaboratively or independently 
  • Demonstrated organizational, communication, and interpersonal skills
  • Ability to exercise discretion and work with commercially sensitive information
  • Effective negotiation and presentation skills 
  • Advanced PC skills

JOB RESPONSIBILITIES*

  1. Creates and implements strategies for agreements that meet Children’s Healthcare of Atlanta  guidelines.
  2. Evaluates opportunities by coordinating pertinent modeling requests to ascertain the impact of financial terms, including reimbursement arrangements.
  3. Develops payor strategy and maintains payor business intelligence.
  4. Leads and develops rate evaluations for proposals and counter proposals.
  5. Assesses risk of various contract provisions, proposes alternates, and coordinates changes suggested by internal stakeholders.
  6. Negotiates terms of managed care agreements.
  7. Assesses the administrative impact to Children’s Healthcare of Atlanta operations of a payor proposal.
  8. Maintains positive working relationships externally.
  9. Provides day-to-day support to internal stakeholders for managed care issues or questions, including high-level oversight of payor adherence to the agreement.
  10. Acts as internal subject matter expert for payor contracts, including representing the interpretation or intent of a provision.
  11. Acts as liaison between payor and Children's Healthcare of Atlanta to solve problems and develop mechanisms to accommodate payor processes.
  12. Coordinates and communicates general administrative or other information that may be requested or needed by a payor.
  13. Maintains, updates, and distributes routine managed care informational reports (e.g., plan matrices outlining key admitting and billing information, rates, deduction projections or renewal information).
  14. Assists in the development, distribution, and presentation of managed care educational and training programs to internal stakeholders.
  15. Participates in contracting forums and actively participates in The Children’s Care Network (or successor) task forces.
  16. Coordinates routine development and distribution marketing materials to payors.
  17. Completes strategic and business plan in conjunction with leadership as required.
  18. Supports and participates in the continuous assessment and improvement of Children's Healthcare of Atlanta through a commitment to the improvement of own skill set and that of the department.
  19. Performs other activities as requested.
  20. Responsible for all aspects of managing and leading a team including: interviewing, hiring, training, developing, directing work and processes, managing performance, recognizing, and rewarding employees.
  21. Mentor team members to encourage personal and professional growth.
  22. Encourage ongoing skill development by providing opportunities for continued education.

SYSTEM RESPONSIBILITIES*

Safety: Practices proper safety techniques in accordance with hospital and departmental policies and procedures. Responsible for the reporting of employee/patient/visitor injuries or accidents, or other safety issues to the supervisor and in the occurrence notification system.

 

Compliance: Monitors and ensures compliance with all regulatory requirements, organizational standards, and policies and procedures related to area of responsibility. Identifies potential risk areas within area of responsibility and supports problem resolution process. Maintains records of compliance activities and reports compliance activities to the Compliance Office.

 

The above statements are intended to describe the general nature and level of work performed by people assigned to this classification.  They are not intended to be an exhaustive list of all job duties performed by the personnel so classified.

PHYSICAL DEMANDS*

Ability to lift up to 15 lbs independently not to exceed 50 lbs without assistance

Bending/Stooping - Occasionally (activity or condition exists up to 1/3 of time)

Climbing - Occasionally (activity or condition exists up to 1/3 of time)

Hearing/Speaking - Effective communication with employees, supervisors/managers and staff. Effective communications with patients and visitors, as required.

Lifting - Occasionally (activity or condition exists up to 1/3 of time)

Pushing/Pulling - Occasionally (activity or condition exists up to 1/3 of time)

Sitting - Frequently (activity or condition exists from 1/3 to 2/3 of time)

Standing - Occasionally (activity or condition exists up to 1/3 of time)

Walking - Occasionally (activity or condition exists up to 1/3 of time)

WORKING CONDITIONS*

No potential for exposure to blood and body fluids

 

About Us:

Children’s Healthcare of Atlanta has been 100 percent committed to kids for more than 100 years. A not-for-profit organization, Children’s is dedicated to making kids better today and healthier tomorrow.

With 3 hospitals, 28 neighborhood locations and a total of 638 beds, Children’s is the largest healthcare provider for children in Georgia and one of the largest pediatric clinical care providers in the country. Children’s offers access to more than 70 pediatric specialties and programs and is ranked among the top children’s hospitals in the country by U.S. News & World Report.

Children’s has been ranked on Fortune magazine’s list of “100 Best Companies to Work For” for thirteen consecutive years and named one of the “100 Best Companies” by Working Mother magazine. We offer a comprehensive compensation and benefit package that supports our mission, vision and values. We are proud to offer an array of programs and services to our employees that have distinguished us as a best place to work in the country. Connect to our mission of making kids better today and healthier tomorrow. 

Have questions about the recruitment process?  Check out What to Expect.

Address:  3375 Northeast Expressway, Atlanta, GA  30341
Function:  Finance/Accounting - Managed Care

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