Supports financial analysis and maintenance of managed care contracts, ensures correct payer reimbursement, assists contract negotiations, communicates process changes, and liaises with internal departments to resolve reimbursement, operational, and clinical issues.
The Payor Relations Coordinator is responsible for assisting in the financial analysis, development, and maintenance of managed care contracts. Ensures that payors reimburse FMOLHS and affiliated entities correctly. Acts as a liaison between the Business Office, Medical Management, Revenue Management and other internal departments to resolve identified issues.
Responsibilities1. Managed Care
- Assists in the development and maintenance of financial information related to volume, financial performance, and profitability for each managed care contract. Prepares preliminary interpretations of analysis for project teams, departments and/or management.
- Assists in developing reimbursement strategies and policies and procedures related to contract negotiations.
- Obtains and maintains current information and knowledge of the managed care environment, including but not limited to local, state and national developments; and develops and maintains relationships with appropriate agencies.
- Assists in contract negotiations.
- Ensures that changes in managed care processes are communicated to and followed by FMOLHS and affiliated entity employees in a manner that ensures high quality patient care.
- Strives to promote the quality and efficiency of his/her own performance by remaining current with the latest trends in field of expertise through participation in job-relevant seminars and workshops.
2. Collaboration and Partnership
- Works collaboratively with internal departments (i.e., Financial Operations, Revenue Management, Business Office, etc.) to ensure reimbursement is optimized and to resolve identified issues. Assists in the resolution of identified operational issues with contracted payers. This includes resolution of reimbursement, operational and clinical issues.
- Works with affiliated entities in the development and maintenance of managed care contracts and strategies.
- 3 years professional level hospital or managed care experience
- Bachelor's Degree
Similar Jobs
58 Seconds Ago
Artificial Intelligence • Fintech • Insurance • Marketing Tech • Software • Analytics
Manage, investigate, and resolve attorney-represented auto and homeowner bodily injury claims. Evaluate coverage, liability, and damages; coordinate with trial counsel; prepare trial reports; ensure reserve adequacy; identify SIU and subrogation opportunities; handle claimant and witness communications; manage outside counsel billing and file security. Training attendance required.
Artificial Intelligence • Machine Learning • Natural Language Processing • Software • Conversational AI
Provide high-touch executive support to the CMO: manage and optimize calendar, run marketing leadership cadence, design Human+AI workflows to automate admin, coordinate cross-functional programs, handle complex travel and same-day expenses, protect confidential information, and proactively remove operational friction to keep leadership focused on strategic work.
Artificial Intelligence • Fintech • Insurance • Marketing Tech • Software • Analytics
Manage a caseload of routine to moderately complex workers' compensation claims: investigate coverage and liability, set and adjust reserves, negotiate settlements within authority, refer files as needed, and collaborate with claimants, policyholders, attorneys, and partners. Participate in required training and occasional onsite work.
What you need to know about the San Francisco Tech Scene
San Francisco and the surrounding Bay Area attracts more startup funding than any other region in the world. Home to Stanford University and UC Berkeley, leading VC firms and several of the world’s most valuable companies, the Bay Area is the place to go for anyone looking to make it big in the tech industry. That said, San Francisco has a lot to offer beyond technology thanks to a thriving art and music scene, excellent food and a short drive to several of the country’s most beautiful recreational areas.
Key Facts About San Francisco Tech
- Number of Tech Workers: 365,500; 13.9% of overall workforce (2024 CompTIA survey)
- Major Tech Employers: Google, Apple, Salesforce, Meta
- Key Industries: Artificial intelligence, cloud computing, fintech, consumer technology, software
- Funding Landscape: $50.5 billion in venture capital funding in 2024 (Pitchbook)
- Notable Investors: Sequoia Capital, Andreessen Horowitz, Bessemer Venture Partners, Greylock Partners, Khosla Ventures, Kleiner Perkins
- Research Centers and Universities: Stanford University; University of California, Berkeley; University of San Francisco; Santa Clara University; Ames Research Center; Center for AI Safety; California Institute for Regenerative Medicine
