Abbott is a global healthcare leader that helps people live more fully at all stages of life. Our portfolio of life-changing technologies spans the spectrum of healthcare, with leading businesses and products in diagnostics, medical devices, nutritionals, and branded generic medicines. Our 109,000 colleagues serve people in more than 160 countries.
WHAT YOU'LL DO
The Payor Contract Specialist is responsible for the negotiation and management of payor contracts for Mechanical Circulatory Support (MCS), Neuromodulation (NMD), CardioMems (CMEMs), and new product lines for Continuum Services. This position will initiate requests for contracts with key payors, prepare reimbursement proposals, review contract language, and negotiate agreements for MCS, NMD, CMEMs, and any other new product lines as applicable. The Payor Contract Specialist will also be responsible for maintenance and updates to payor contracting documentation and reference materials, and will work cross-functionally to ensure contracts are implemented across Continuum departments, including billing, customer service and sales. The Payor Contract Specialist will be responsible for maintaining relationships with payor representatives and will facilitate meetings with payors to improve collections and resolve administrative or contract compliance issues.
The duties and responsibilities for this position include, but are not limited to, the following:
Prepare proposals for pricing strategies for new products, and contracts.
Negotiate contracts with health care payors for MCS, NMD, CardioMEMs product lines from the beginning of negotiation of rates and language through execution and implementation.
Negotiates health care payor contracts to broaden payor network access for Continuum business.
Redline health care payor contracts with recommendations to legal team, as applicable.
Prepare new Amendments and Addendums to contracts as needed for new products, coding changes, etc., and obtain legal review as needed.
Negotiate and execute new Amendments and Addendums with payors through implementation.
Ensure compliance with company's contracting policies, procedures and the smooth operation/administration of provider agreements.
Complete and submit payor credentialing / re-credentialing applications for new payor contracts.
Work cross-functionally to ensure contracts, amendments, etc. are implemented as intended including ensuring contracts are loaded appropriate to ensure accuracy for authorization, billing and claims functions.
The scope of the contracts includes national health insurance companies, national payor networks, managed care organizations, hospital health systems, medical groups, IPAs, third party administrators (TPA), reinsurance companies, and workers compensation payors/networks.
Manage record keeping of payor contracts and amendments, reference materials, and other supporting documentation on the shared drives / SharePoint sites.
Communicates regularly with billing to review large payor payment trends. Facilitate meetings with payors as needed to improve collections or resolve administrative or contract compliance issues.
Responsible for preparation of reports and special projects.
Works closely with the National Payor Contracting Manager, LOA Specialists, and Manager, Payor Contract Implementation.
Adheres to Abbott guidelines including safeguarding all proprietary and confidential information.
Assists Continuum team members on issues, concerns, and strategies regarding the Continuum business.
Attends conferences and conventions as needed.
Ability to communicate with payor medical director, hospital administration, medical directors, case managers, nurses, doctors and corporate legal counsel.
Educates and inform Continuum team members on payor contract requirements.
Performs other duties and responsibilities as required or requested, including travel when necessary.
EDUCATION AND EXPERIENCE YOU'LL BRING
A bachelor's degree or equivalent experience is required, including 5 or more years of relevant working experience in provider/payor contracting in a managed care or hospital setting.
Extensive knowledge of health insurance plans (Medicare, Medicaid, Managed Care, PPO, POS, Self-funded, TPAs, Workers Comp, etc.) and health care environment.
Working knowledge of HCPCS and ICD-10 codes.
Working method can be characterized as taking on responsibility with independence or autonomy; self-directed.
Works well with management, and peers.
Computer literacy required, specifically with MS Word (including track changes to redline contracts), Excel and business systems.
Excellent written and verbal communication skills.
Advanced knowledge of provider contracts and health care reimbursement and ability to negotiate effectively with internal/external stakeholders and payers.
Payors includes national payors, national networks, managed care organizations (HMO, PPO, POS, EPO), providers at financial risk (hospital/health system, medical group and IPA), Self-funded plans, Third Party Administrators, and Workers Compensation payors/networks.
Must have skill in negotiating contracts and agreements.
WHAT WE OFFER
At Abbott, you can have a good job that can grow into a great career. We offer:
Training and career development, with onboarding programs for new employees and tuition assistance
Financial security through competitive compensation, incentives and retirement plans
Health care and well-being programs including medical, dental, vision, wellness and occupational health programs
Paid time off
401(k) retirement savings with a generous company match
The stability of a company with a record of strong financial performance and history of being actively involved in local communities
Follow your career aspirations to Abbott for diverse opportunities with a company that provides the growth and strength to build your future. Abbott is an Equal Opportunity Employer, committed to employee diversity.
Abbott is a global healthcare leader that helps people live more fully at all stages of life. Our portfolio of life-changing technologies spans the spectrum of healthcare, with leading businesses and products in diagnostics, medical devices, nutritionals and branded generic medicines. Our 109,000 colleagues serve people in more than 160 countries.