Third Party Payor Implementation Associate

Responsible for administrating Medline's third party payer contracts programs including those involving Medicare Part B. Medicaid, and other government or commercial payers.
Manage and monitor all distribution implementations in accordance with the terms of the payer contract. Collaborate with Sales force to validate program selections and details with payer, develop and execute implementation strategy, project plan, and timeline.

• Manage and monitor all distribution implementations in accordance with the terms of the payer contract. Collaborate with Sales force to validate program selections and details with payer, develop and execute implementation strategy, project plan, and timeline
• Track all implementation/customer-payer accounts for the first 90 days of distribution until the account reaches an agreed upon steady state.
• Assess progress & report status to leadership, including progress, timeline & milestones via timely written or verbal communication
• Initiate credentialing and maintain re-credentialing and re-validation of provider within the payer networks.
• Manage the payer contracting process from application to implementation.
• Manage payer/provider data base with SAP and Triage software. Maintain current payer files and other records in accordance with HIPAA Compliance, Company instructions and requirements.
• Collaborate and communicate with relevant functional groups (Billing & Reimbursement teams, Customer Service, Finance, and Regulatory) throughout contracting process to provide updates, discuss potential operational issues, develop and follow up on related action steps.
• Conduct pricing and profit/loss analysis in accordance with fee schedules.
• Assist in regular analysis of contracting needs including the assessment of utilization data to identify areas for new and re-negotiated contracts.
• Review, prepare and assist RVPs/SVPs in the RFP process.
• Provide support to other departments to ensure compliance with corporate contracting standards (i.e. Operations, Regulatory, etc.).
• Interact directly with Third Party Payers and Vendors as needed for issues relating to contracting, reimbursement, EFT and portal access/setups. Participate in provider orientations with Managed Care Payers.
• Actively pursue new payers at a local level. Distribute program sales materials to outside sales representatives.

Medline offers a business casual, entrepreneurial work environment with strong growth potential, a competitive compensation package, and a complete benefits package including medical/dental/vision/life insurance; 401(k) with company match. And much more!

Qualification

Education

• High school diploma or equivalent.

Relevant Work Experience

• At least 3 years of credentialing and contracting experience preferred

Additional

• Intermediate skill in Microsoft Excel
• Intermediate level skill in Microsoft Word
• Experience applying knowledge of Medicare, Medicaid and Commercial payers, its rules and reimbursement.
• DME experience a plus