Payor Coordinator Analyst - Value Care Contracts

Payor Coordinator Analyst - Value Based Care Contracts - Southwestern Health Resources

Payor Coordinator Analyst – Value Based Care Contracts - Southwestern Health Resources

Work Hours:

Full Time Days (8:00am-5:00pm) for 40 hrs/week (remote work allowed at manager's discretion)

Department Highlights:

• Hybrid Position
• Gain a sense of accomplishment by contributing to a teamwork environment.
• Receive excellent mentorship, comprehensive training, and dedicated leadership resources.
• Contribute and work on a cross functional team

Contract Management Support:
Value – Based Care Contracts

While this role is focused heavily on value-based care contracts, the PCA will support the other managed care functions as needed.

• Review and interpret payor contracts to understand contract language, financial incentives, and other relevant items of the contract.
• Assist with maintaining contract language key terms by payor tracking grid.
• Prepare routing documents for new contracts and amendments.
• Review and redline low-level amendments (e.g., term extensions, quality measure updates) and exhibits.
• Complete and distribute new contract orientation forms and communications to internal stakeholders.
• Maintain organized records of contract status, amendments, and stakeholder communications.

30%

Project Management:

• Maintain project tracker by payor (e.g., Aetna, BCBSTX, Cigna, UHC) and monitor project status.
• Participate in payor calls, identify trends, work with payors to resolve issues and document outcomes.
• Escalate unresolved issues to appropriate parties and follow through to resolution.
• Maintain and update project trackers, ensuring alignment with internal stakeholders and timelines.

30%

Contract Operations – New Contracts and Amendments

• Interpret and communicate contract or contract changes to internal stakeholders.
• Collaborate with analysts to assess the financial implications of a new contract or contract amendments for internal stakeholders.
• Notify payors of significant impacts within required time frames and monitor resolution status.
• Document and communicate new contract and contract changes and outcomes to relevant internal teams.

10%

Managed Care Projects & Provider/Payor Queries

• Support cross-functional managed care initiatives and respond to provider or payor-related queries.
• Communicate with providers, payors, internal stakeholders (quality, medical economics, finance), and others to resolve issues and improve processes.
• Collect, organize, and present data in a clear and actionable format.
• Provide timely updates and final reports to requesting departments or leadership.
• Ensure all project documentation is complete, accurate, and accessible.

20%

Committee Participation

• Represent the Market and Payor Relations team in internal and external meetings, committees, and work groups.
• Actively participate in discussions, share insights, and contribute to strategic planning efforts.
• Build and maintain strong relationships with providers, payors and internal departments to support collaborative problem-solving.

10%

Education

• Bachelor's Degree in Business or Healthcare – 4 Years Required
• Master's Degree in Business or Healthcare – Preferred

Experience

• 4 Years of Experience in managed care, payor relations, or healthcare operations – Required

Skills

• Familiarity with healthcare payor systems and contract language.
• Experience with policy impact analysis and claims resolution.
• Ability to work independently and collaboratively in a fast-paced environment.
• Excellent project management and problem-solving skills.
• Detail-oriented.
• Strong analytical skills.
• Excellent oral and written communication skills.

Supervision:
Individual Contributor

Budget Responsibility:
Primary Budget Responsibility Less than $100 Thousand ($80k - 110k)

ADA Requirements:
Working Indoors 67% or more

Physical Demands:
Sedentary