Healthcare Payer Contracts Administrator (DME)

ABC Home Medical Supply, Inc is one of the nation’s leading urological supply providers and serves as a one-stop shop with a comprehensive line of medical supplies and service that includes: Urological, Incontinence, Wound Care, and Ostomy.  ABC Medical is part of the JDS, Inc family of businesses.  Our service companies possess the knowledge and expertise to deliver first-class products and personalized home healthcare services.

Location: Nashville 
Department:  

 

Work Location: Port Saint Lucie, FL or Nashville, TN

Hybrid work schedule Monday-Friday

 

Responsibilities:

The Contract Administrator provides oversight, management, coordination, organization, and communication of payor contracting activities for each of the ABC Medical family of companies.  The Contract Administrator is responsible for maintaining all company payer agreements, addendums, renewal terms, and required notification or due dates.  The position interprets all payer requirements and ensures that those requirements are systematically implemented in company operating processes.  The Contract Administrator collaborates with the sales team and internal departments to communicate contracting status and evaluate opportunities for contract expansion.  The Contract Administrator improves ABC profitability through analysis of payer rules, payer denials, and internal processes.    

• Pursue, negotiate, and maintain contracts with all payers, e.g., insurance companies, IPAs, TPAs and government programs.
• Understand insurance policies and regulatory guidelines to implement systematic parameters that ensure compliance with payer-specific rules and requirements.
• Provide payer expertise, analysis, and contract understanding to support operational teams with improvements that reduce billing denials and improve collection.
• Understands and identifies profitability opportunities within assigned payers.
• Facilitate the payer contracting process, in conjunction with Legal and Credentialing teams, to ensure accurate, compliant contract documents from pre-contract through post-contract phases.
• Provide contract summaries and execute contracts in accordance with company policy.
• Support monthly reporting to senior management and organizational stakeholders with progress and status of contracted payor agreements.
• Supports the maintenance of a common provider directory/database for enrollment with payers.
• Supports the research of territories to identify gaps in payer base to support contract expansion. 
• Assist with all contracting administration and projects, as needed.

 

Minimum Qualifications:

• Associate or bachelor’s degree, or 5 years of relevant healthcare contract experience
• Ability to interact professionally and ethically with team members, all levels of management, government agencies, and insurance payer personnel
• Ability to manage multiple tasks simultaneously in a fast-paced environment
• Ability to provide clear, concise oral and written communications
• Ability to handle special requests in a sensitive, professional manner
• Strong attention to detail and follow through skills 
• Meticulous organization and filing skills 

 

Preferred Qualifications:

• Experience working at a medical insurance company, IPA, TPA highly preferred
• Familiarity and experience with DME and/or Medical Supply reimbursement, including Medicare, Medicare Managed, Medicaid, and Medicaid Managed plans.
• Knowledge and use of Brightree software preferred but not required.
• Advanced Microsoft Office experience
• Ability to troubleshoot complex payor events

 

Here’s what we have to offer:

• Variety of Medical, Dental and Vision Insurance Plans