Payor Relations Analyst

Job Description:

At Enovis™ we pay attention to the details. We embrace collaboration with our partners and patients. We take pride in the pursuit of scientific excellence — with the goal of transforming medical technology as we know it.

Because that’s how we change the lives of patients for the better. And that’s how we create better together. Why work at Enovis? . See for yourself

As a key member of the Payor Development Team, you will play an integral part in helping Enovis drive the medical technology industry forward through transforming patient care and creating better patient outcomes.

Job Title:

Payor Relations Analyst

Reports To:

Director, RCM Operations

Location:

Dallas Headquarters (2900 Lake Vista Drive, Suite 200, Lewisville, TX 75067)

Business Unit Description:

Revenue Cycle Management (RCM)

Job Title/High-Level Position Summary: The Payor Relations Analyst is responsible for providing daily administrative support for insurance payor contract uploads, fee schedule updates, contract rate reviews, re-credentialing submissions and timely response to payor questions to both internal and external customers. This position is also responsible for quality control of the Payor Entry Database, payor contracts, and ensuring that contracts are compliant with the agreed upon terms.

Key Responsibilities:

• Maintains relevant reimbursement payor databases including policy, billing, pricing information, contract agreements, and non-contracted payor demographics.
• Monitors, audits, and follows up on all new agreements at 60-120-180 days to ensure the agreement is functioning appropriately with all reports and resources provided.
• Proactively identifies trends that are attributing to aged Accounts Receivable and contractual write-offs resulting from payor (external) and operational (internal) non-compliance with the contract and problem-solves with the appropriate party (i.e., payor and/or internal departments).
• Responsible for all credentialing and licensure requests from payors to maintain current accreditation and access to plan members under assigned geographic region.
• Applies, maintains, and updates all State Medicaid plan information.
• Monitors State Medicaid website, provider portal, and fee schedules, and completes annual enrollment and/or credentialing/attestations to ensure Enovis has an in-network participating status under assigned geographic region.
• Researches and responds to inquiries from internal departments regarding contracted payors’ participation status, and internal operational processes.
• Works with Payor Development Leadership to interpret third-party payor coverage policies, maintaining documentation requirements necessary to support Medical Necessity of Enovis products and services.

Minimum Basic Qualifications:

• 3 – 5 years’ experience in a medical reimbursement environment (e.g., patient billing, claims processing, healthcare/insurance contracting support).
• Proficiency in insurance/payor reimbursement including an understanding of payors on a national scale.
• Demonstrated knowledge of managed care and other payor’s guidelines and criteria for reimbursement.
• Demonstrate ability to interpret payor policy and criteria
• Exceptional verbal and written communication skills to internal and external customers required.

Travel Requirements:

• Must be able to travel up to 5% of the time.

Desired Characteristics:

• 3-5 years payor credentialing experience with DME provider.

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“Creating better together”. It’s the Enovis purpose, and it’s what drives us and empowers us every day on a global scale. We know that the power to create better – for our customers, our team members, and our shareholders – begins with having the best team, pursuing common goals, operating at the highest levels, and delivering extraordinary outcomes.

What does creating better together mean to us at Enovis? Discover the “why” behind our purpose, values and behaviors:

Our Enovis Purpose, Values and Behaviors on Vimeo

We offer a comprehensive benefits package that includes:

• Medical Insurance
• Dental Insurance
• Vision Insurance
• Spending and Savings Accounts
• 401(k) Plan
• Vacation, Sick Leave, and Holidays
• Income Protection Plans
• Discounted Insurance Rates
• Legal Services