Payer Relations Specialist

Summary:

The Payer Relations Specialist supports managed care operations by serving as the primary operational liaison between Akron Children's and assigned thirdparty payers. The role focuses on daytoday relationship management, issue tracking and escalation, payer communication, and performance monitoring to support patient access, accurate reimbursement, and contract compliance. The Specialist collaborates with internal stakeholders to resolve payerrelated operational issues and supports advocacy efforts aligned with pediatric care needs.

Responsibilities:

1. Serve as the daytoday operational contact for assigned payers, managing routine communications, inquiries, and issue escalation.

2. Monitor and document payer policy, medical guideline, and reimbursement changes; assess operational impact on pediatric services.

3. Coordinate and support payer meetings, including joint operating committees, performance reviews, and issue resolution discussions.

4. Track and facilitate resolution of payer issues such as claim denials, prior authorization delays, processing errors, and underpayments, escalating as appropriate.

5. Prepare and maintain payer performance materials, including issue logs, reports, scorecards, and stakeholder summaries.

6. Support payer education and advocacy efforts by compiling data related to hospital capabilities, outcomes, and pediatric value proposition.

7. Assist with monitoring payer contract compliance and network participation to identify and prevent patient access barriers.

8. Collaborate with Revenue Cycle, Utilization Management, Payer Analytics, Contracting, and clinical teams on payerrelated initiatives and process improvements.

9. Maintain accurate payer documentation and provide administrative support for payer relations activities, including scheduling, agenda preparation, and followup.

10. Other duties as assigned.

Other information:

Technical Expertise

1. Working knowledge of payer operations, including prior authorization processes, claims adjudication, and denial management.

2. Understanding of pediatric healthcare reimbursement and payer requirements, including Medicaid MCOs, CHIP, and commercial insurers.

3. Proficiency in Microsoft Office applications, particularly Excel, Word, and PowerPoint, and payer provider portals.

4. Familiarity with revenue cycle terminology, medical coding (ICD-10, CPT), and healthcare regulatory requirements (e.g., HIPAA, ACA).

5. Ability to analyze operational data to identify trends and support issue resolution.

6. Strong written and verbal communication skills for professional correspondence and collaboration.

7. Ability to manage multiple priorities, maintain accurate records, and meet deadlines.

8. Demonstrated attention to detail and ability to handle confidential information.

9. Demonstrated project coordination capabilities to support meetings, maintain issue and action logs, and ensure timely followthrough.

Education and Experience

1. Education: Bachelor's degree required, Healthcare Administration, Business, Communications, or related field preferred.

2. Licensure: None

3. Certification: None

4. Years of relevant experience: Minimum of 2 years of experience in payer relations, managed care, revenue cycle, or customer service within a healthcare setting required. Experience in a children's hospital or pediatric environment is strongly preferred, with exposure to Medicaid and commercial payer interactions.

5.Years of supervisory experience: None

Full Time

FTE: 1.000000

Status: Remote