About the role
%3Cp class=%22MsoNormal%22 style=%22text-align:center;%22%3E%3Cstrong%3EPayor Operations Coordinator%3C/strong%3E%3C/p%3E%3Cp class=%22MsoNormal%22 style=%22text-align:center;%22%3E%3Ci%3E%3Cstrong%3EBring your passion to Texas Health so we are Better + Together%3C/strong%3E%3C/i%3E%3C/p%3E%3Cp class=%22MsoNormal%22%3E%3Ci%3E%3Cstrong%3E%26nbsp;%3C/strong%3E%3C/i%3E%3C/p%3E%3Cp class=%22MsoNormal%22%3E%3Cstrong%3EWork Location:%26nbsp;Texas Health Corporate, 612 E. Lamar Blvd., Arlington, TX 76011%3C/strong%3E%3C/p%3E%3Cp class=%22MsoNormal%22%3E%3Cstrong%3EWork Hours:%26nbsp;Full Time Days (8:00am-5:00pm) for 40 hrs/week (Hybrid work allowed at manager%27s discretion)%3C/strong%3E%3C/p%3E%3Cp class=%22MsoNormal%22%3E%3Cstrong%3EDepartment Highlights:%3C/strong%3E%3C/p%3E%3Cul style=%22margin-top:0in;%22 type=%22disc%22%3E%3Cli class=%22MsoNormal%22 style=%22mso-list:l0 level1 lfo1;tab-stops:list .5in;%22%3E%3Cstrong%3EHybrid Position%3C/strong%3E%3C/li%3E%3Cli class=%22MsoNormal%22 style=%22mso-list:l0 level1 lfo1;tab-stops:list .5in;%22%3E%3Cstrong%3EGain a sense of accomplishment by contributing to a teamwork environment.%3C/strong%3E%3C/li%3E%3Cli class=%22MsoNormal%22 style=%22mso-list:l0 level1 lfo1;tab-stops:list .5in;%22%3E%3Cstrong%3EReceive excellent mentorship, comprehensive training, and dedicated leadership resources.%3C/strong%3E%3C/li%3E%3C/ul%3E%3Cp%3E%3Cstrong%3EWhat You Will Do:%3C/strong%3E%3C/p%3E%3Cp%3EContract management:%3Cbr%3E. Collaborate with revenue cycle operations, finance and clinical terms to align payor strategies with operational initiatives.%3Cbr%3E. Assist in developing and maintaining a comprehensive database of contractual terms and rates for all Texas Health providers, inventory and archiving contracts.%3Cbr%3E. Exercise independent judgment in interpreting contract terms and determining appropriate alternatives for operational application.%26nbsp;%3Cbr%3E. Review and assess reimbursement trends, denials, and payment discrepancies to identify root causes, and recommend corrective actions.%26nbsp;%3Cbr%3E. Responsible for contract administration and implementation:%3Cbr%3E. Coordinate communication with the final contract terms to internal stakeholders (i.e. Patient Access, Revenue Cycle, Medical Management, Contract Management, Finance, Facilities, Ancillary Providers, Physicians).%3Cbr%3E. Coordinate contract implementation with the business office and ITS to ensure the contracts are loaded per the intent and work with SWHR and Payors on contract interpretation issues.%3Cbr%3E. Coordinate communication with other departments/entities on payor activity and new contracts through the system.%3Cbr%3E. Gather, log, and monitor escalated payor-related issues from internal departments. Analyze, coordinate and combine reimbursement trends, denials and payment discrepancies to identify root cause/trends and areas for improvement.%3Cbr%3E. Prepare and present analytical reports and recommendations regarding payor performance, contract compliance, and reimbursement risk to leadership and cross-functional stakeholders.%26nbsp;%3Cbr%3E. Develop and maintain ongoing collaborations and partnerships with SWHR and Payors and serve as the interface with SWHR and Payors for operational, financial and contract compliance issues.%3Cbr%3E. Track, document and monitor payor policy updates to identify any operational and financial impact. Route contract-related issues to internal teams and SWHR as appropriate. 60%%3Cbr%3ECompliance:%3Cbr%3E. Monitor payor policy updates and regulatory changes and share impacts with internal stakeholders.%3Cbr%3E. Support Contract Analyst by assisting with validation of rate loads, reimbursement discrepancies, and transparency requirements.%3Cbr%3E. Recommend procedural or workflow changes to address compliance risks, reimbursement exposure, or audit findings related to payor policies and regulatory requirements.%26nbsp;%3Cbr%3E. Participate in development and maintenance of departmental guidance, documentation, and procedural standards related to payor operations. 25%%3Cbr%3EAdministrative:%3Cbr%3E. Prepare agendas and maintain accurate minutes for internal meetings, payor meetings, and cross-functional workgroups synthesizing complex payor information into actionable steps.%3Cbr%3E. Assist with reports, dashboards, and analytics to support contract performance and operational insights.%3Cbr%3E. Coordinate and support SWHR with Centers of Excellence (COE) surveys and related documentation.%3Cbr%3E. Assist with the credentialing and recredentialling process for healthcare providers.%3Cbr%3E. Coordinate requests for provider demographic data in a centralized location and update master provider demographic data for facilities, ancillary providers and physicians. Determine appropriate points of contact for information.%3Cbr%3E. Other projects/ duties as assigned. 15%%3C/p%3E%3Cp%3E%3Cstrong%3EWhat You Need:%26nbsp;%3C/strong%3E%3C/p%3E%3Cp%3E%3Cstrong%3EEducation%3C/strong%3E%3Cbr%3EBachelor%27s Degree Business, Healthcare, or related field Req%3C/p%3E%3Cp%3E%3Cbr%3E%3Cstrong%3EExperience%3C/strong%3E%3Cbr%3E4 Years Experience in managed care, provider relations, payor relations, revenue cycle management, health care or related field Req%3Cbr%3E2 Years Experience in multi-entity hospital systems or value-based program environments. Pref%3C/p%3E%3Cp%3EUnderstanding of contract provisions, healthcare reimbursement methodologies, payor policy structures, regulations and compliance requirements across hospital, ancillary provider and physicians. Preferred%3C/p%3E
%3Cp%3E%3Cstrong%3EEducation%3C/strong%3E%3Cbr%3EBachelor%27s Degree Business, Healthcare, or related field Req%3Cbr%3E%3Cbr%3E%3Cstrong%3EExperience%3C/strong%3E%3Cbr%3E4 Years Experience in managed care, provider relations, payor relations, revenue cycle management, health care or related field Req%3Cbr%3E2 Years Experience in multi-entity hospital systems or value-based program environments. Pref%3C/p%3E%3Cp%3EUnderstanding of contract provisions, healthcare reimbursement methodologies, payor policy structures, regulations and compliance requirements across hospital, ancillary provider and physicians. Preferred%3Cbr%3E%3Cbr%3E%3Cstrong%3ESkills%3C/strong%3E%3Cbr%3EExcellent organizational skills, verbal and written communication skills required.%3Cbr%3EAbility to collaborate with cross-functional teams.%3Cbr%3EProficiency with Microsoft Office applications.%3Cbr%3EUnderstanding of contract provisions, healthcare reimbursement methodologies, payor policy structures, regulations and compliance requirements across hospital, ancillary provider and physicians.%3Cbr%3EAbility to manage multiple deadlines and escalate issues appropriately.%3Cbr%3EReliable transportation for meetings and travel as needed.%3Cbr%3E%3Cbr%3E%3Cstrong%3ESupervision%3C/strong%3E%3Cbr%3EIndividual Contributor%3Cbr%3E%3Cbr%3E%3Cstrong%3EADA Requirements%3C/strong%3E%3Cbr%3EExtreme Heat 1-33%%3Cbr%3EExtreme Cold 1-33%%3Cbr%3EExtreme Swings in Temperature 1-33%%3Cbr%3EExtreme Noise 1-33%%3Cbr%3EWorking Outdoors 1-33%%3Cbr%3EWorking Indoors 1-33%%3Cbr%3EMechanical Hazards 1-33%%3Cbr%3EElectrical Hazards 1-33%%3Cbr%3EExplosive Hazards 1-33%%3Cbr%3EFume/Odor Hazards 1-33%%3Cbr%3EDust/Mites Hazards 1-33%%3Cbr%3EChemical Hazards 1-33%%3Cbr%3EToxic Waste Hazards 1-33%%3Cbr%3ERadiation Hazards 1-33%%3Cbr%3EWet Hazards 1-33%%3Cbr%3EHeights 1-33%%3Cbr%3EOther Conditions 1-33%%3Cbr%3E%3Cbr%3E%3Cstrong%3EPhysical Demands%3C/strong%3E%3Cbr%3ESedentary%3Cbr%3E%3Cbr%3E%3Cstrong%3ETravel Requirements%3C/strong%3E%3Cbr%3ELocal 5% Potential travel to entity locations and payor meetings.%3C/p%3E
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