Aveanna Healthcare Job - 29437164 | CareerArc
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Company: Aveanna Healthcare
Location: Mount Laurel, NJ
Career Level: Mid-Senior Level
Industries: Healthcare, Pharmaceutical, Biotech


The Payer Relations Manager is a highly specialized sales professional who works with our branch and area leadership to develop a strategic plan for growing relationships with assigned Medicaid Managed Care Organizations. The Payer Relations Manager is responsible for growing/developing relationships with the case management department, educating/managing administrative and office functions, and census growth through referral management.

Essential Job Functions
Meetings with area team leadership on weekly, monthly, and long term MCO goals
Contact case managers within your assigned Managed Care Organizations (MCOs) daily
Hold bi-annual to quarterly meetings with directors, managers, or leadership of various MCO departments (case management, revenue cycle, provider relations)
Prepare standard metrics for all MCO meetings (census breakdown, staffing percentages, and any additional metrics which highlight our value points)
Collaborate with Director of Payer Relations to manage and grow relationships with designated MCOs
Communicate or coach branch locations with having difficult conversations regarding patient scheduling, compliance and legal concerns, etc.
Coordinate with clinical team on providing patient status updates and coordinating physician orders
Complete knowledge and branch education on MCO authorization/re-authorization and appeals/dispute process- benefits expert
Partner with Regional Revenue Cycle Managers to manage contract billing terms and issues that are contributing to increasing A/R
Map out and maintain organization charts for assigned MCOs
Develop or update payer profiles for assigned MCOs in coordination with Director of Payer Relations
Oversee required reports that are sent to MCOs and generate data that provides valuable insight
Control service related discharges by reviewing open needs lists, reviewing missed shift reports, and coordination with MCO
Understand MCO process flow for referrals and coordinate with appropriate branch (or CRD) to secure staff
Regular coordination with Client Relation Directors on payer matters that may be delaying discharge
Communicate all MCO referral progress with appropriate parties
Encourage ongoing communication between branch locations and contacts at MCO
Develop practice efficiencies that benefit Aveanna and assigned MCOs

2+ years experience with MCO authorization process
Comprehensive knowledge of all Aveanna business lines and ability to articulate
Basic Understanding of Revenue Cycle Management
In depth understanding of healthcare benefits (HMO, PPO, ACO, Medicare, Medicaid, etc.)
Experience in public speaking

Additional state specific requirements:
Maintain knowledge of state legislation that could impact our industry
Understand state specific regulations that govern our practices and those of the MCOs
Communication with state industry associations

Experience with PDN authorization processes
Proven sales track record
Extensive knowledge of the Private Duty Nursing industry
Basic contracting and credentialing knowledge

Other Skills/Abilities
Proficient in Microsoft Word and Excel
Ability to run various reports in EMR systems
Must be able to adhere to confidentiality standards and professional boundaries at all times
Ability to remain calm and professional in stressful situations
Attention to detail
Time Management
Effective problem-solving and conflict resolution
Excellent organization and communication skills
Leadership skills
Quick-thinking and astute decision making skills
Ability to train and supervise staff

Physical Requirements
Must be able to speak, write, read and understand English
Must be able to travel
Must be able to lift 50 pounds
Prolonged walking, standing, bending, kneeling, reaching, twisting
Must be able to sit and climb stairs
Must have visual and hearing acuity
Must have strong sense of smell and touch

Multiple branch locations within coverage area of MCO
Comfortable presenting industry and Aveanna specific knowledge with high level employees at MCOs
Performs duties in an office environment during agency operating hours
Must be able to function in a wide variety of environments which may involve exposure to allergens and other various conditions
Possible exposure to blood, bodily fluids and infectious diseases

Other Duties
Maintaining branch contact lists provided to MCOs

Equal Employment Opportunity and Affirmative Action: Aveanna provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Aveanna complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.

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