Payer Relations Specialist

Position Summary:

The Payer Relations Specialist works with a team of professionals representing Aware Recovery Care (in-home addiction treatment). The Payer Relations Specialist plays a key role in identifying large and small commercial payers by state, contracting and credentialing payers, and evangelizing the latest innovation in substance use disorder treatment to the payer community. The Payer Relations Specialist will be part of a world class team that includes business development, regulatory compliance, expansion and clinical operations.

Reports To:

Director, Payer Relations

Duties & Responsibilities:

• Develop new managed care contracts and modifications of existing managed care contracts nationwide
• Establish and communicate regularly with contracting representatives for identified plans
• Participate in the development and administration of alternative payment models (VBP contracts), including bundled payments, risk sharing and global payment arrangements 
• Participate in the development of management reporting systems to measure, track and monitor utilization and financial performance of managed care contracts 
• Assist internal clients with the resolution of complex payer issues
• Coordinate meetings with contracted payers to address operational and/or payment issues and recommend changes to internal processes as needed
• Establish and maintain positive working relationships with internal and external customers to improve quality outcomes while optimizing reimbursement or lowering costs
• Adhere to compliance policies, and any applicable laws and regulations 
• Adhere to Aware Recovery Care’s strategic approach to managed care payer contracting

Qualifications & Requirements:

• Bachelor’s Degree preferred
• 3 - 5 years behavioral health contracting or related experience
• Value-Based Payment contract experience a plus
• Experience working directly with contracting and credentialing departments at Optum, Cigna, TriCare
• Experience in the addiction treatment space
• Ability to use electronic health records, phone systems, customer resource management software, and more general office computer systems
• Strong interpersonal and communication skills, proven research and analytical skills and ability to handle multiple priorities
• Professional and proficient written and verbal communication

Key Competencies:

• Strong organization skills
• Efficient work ethic 
• Ability to easily adapt and multitask 
• Ability to collaborate and perform in a team-oriented environment
• Professional and proficient written and verbal communication 
• High level of integrity and professionalism 
• Goal and results-oriented 
  • Resilient and able to perform under pressure 
  • Critical thinker 
  • Reliable 
  • Strives for excellent standards of quality 

• Commitment to ongoing learning and growth

Timekeeping & Punching:

• All non-exempt employees are required to use the timekeeping system to record their hours worked. Non-exempt employees are required to clock in/out for time off and other leave tracking purposes.
• Employees should clock in no sooner than five minutes before their schedule shift and clock out no later than five minutes after their scheduled shift. Additionally, employees are required to clock in/out for their designated lunch periods. The length of the lunch period should have the agreement of the employee’s manager. Lunch periods are unpaid time when employees are relieved of all duties.
• Waiver of the lunch period requires prior approval of the employee’s manager. Under no circumstance may the waiver of the lunch period result in overtime work. 
• Should an employee miss an entry into the timekeeping system, the employee will notify their manager as soon possible for correction. Employees may not ask another employee to clock in/out for them. 
• Accurate time reporting is a federal and state wage and hour requirement, and employees are required to comply. Failing to enter time into the timekeeping system in an accurate and timely manner is unacceptable job performance. 
• Non-exempt employees are not permitted to work overtime or unscheduled time without prior authorization from their manager. This includes clocking in early, clocking out late, or working through the scheduled lunch period. 

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