OHN Payor Network Operations Manager (Regional Remote)

We've made a lot of progress since opening the doors in 1942, but one thing has never changed - our commitment to serve, heal, lead, educate, and innovate. We believe that every award earned, every record broken and every patient helped is because of the dedicated employees who fill our hallways.

At Ochsner, whether you work with patients every day or support those who do, you are making a difference and that matters. Come make a difference at Ochsner Health and discover your future today!

This job develops, manages, and enhances payor relationships to create operational efficiencies and ensures network compliance in high performance payor networks and value-based agreements. Educates operational departments regarding payor network requirements, implements automated processes, identifies enhancement opportunities, and coordinates payor issue resolution. Supports revenue enhancement and organizational growth. Manages and develops staff and ensures and oversees the collection and distribution of accurate network provider data to contracted health plans and networks.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential duties.

This job description is a summary of the primary duties and responsibilities of the job and position. It is not intended to be a comprehensive or all-inclusive listing of duties and responsibilities. Contents are subject to change at the company's discretion.

Education

Required - High school diploma

Preferred - Bachelor's degree in accounting, finance, business administration, health administration, or public health

Work Experience

Required - 7 years of experience negotiating/implementing contracts network operations and/or provider/payor relations

3 years of experience implementing contracts and/or provider/payor relations with a Bachelor's in accounting, finance, business administration, health administration, public health or related field

Knowledge Skills and Abilities (KSAs)

• Leadership skills and ability to manage relationships and understand financial data sufficient to analyze trends and make recommendations.
• Excellent judgment and decision-making skills.
• Ability to be self-directed, work independently, set priorities and maintain complete confidentiality.
• Interpersonal skills and ability to work collaboratively with physicians, administration, and payors.
• Computer skills and proficient with Windows-style applications.
• Proficiency in using computers, software, and web-based applications, including a working knowledge of Microsoft Office products and a high proficiency in Microsoft Excel and Word.
• Effective verbal and written communication skills and ability to present information clearly and professionally to varying levels of individuals throughout the patient care process.
• Ability to work a flexible schedule (e.g. 24/7, weekend, holiday, on call availability) and travel throughout and between facilities.

Job Duties

• Develops and maintains relationships with payors and evaluates and analyzes processes with practices, ensuring contract compliance and operational profitability.
• Manages data to ensure accurate payor network participation criteria are met and the progress towards goals is communicated to partner health plans and network administrators.
• Meets and works closely with payors regarding network adequacy within partner health plans, including determining provider eligibility and ensures discrepancies are addressed in a timely manner.
• Manages payor rosters and ensures information is entered correctly within data management programs and correctly formatted to provide to analytics teams.
• Manages research, education & training programs related to payor networks and value-based agreements and educates operational departments to ensure understanding of network criteria.
• Collaborates with Managed Care team to understand value-based agreements and the benefits of developing and maintaining relationships with payors to better address issues with practices.
• Works with departments, including company physician partners and performance improvement, to solicit feedback regarding network providers within payor networks and addresses with payors, as needed.
• Manages and provides guidance to employees regarding payor relations within value-based networks.
• Performs other related duties as assigned.

The above statements describe the general nature and level of work only. They are not an exhaustive list of all required responsibilities, duties, and skills. Other duties may be added, or this description amended at any time.

Remains knowledgeable on current federal, state and local laws, accreditation standards or regulatory agency requirements that apply to the assigned area of responsibility and ensures compliance with all such laws, regulations and standards.

This employer maintains and complies with its Compliance & Privacy Program and Standards of Conduct, including the immediate reporting of any known or suspected unethical or questionable behaviors or conduct; patient/employee safety, patient privacy, and/or other compliance-related concerns. The employer is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, or disability status.

Physical and Environmental Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Sedentary Work - Exerting up to 10 pounds of force occasionally (Occasionally: activity or condition exists up to 1/3 of the time) and/or a negligible amount of force frequently (Frequently: activity or condition exists from 1/3 to 2/3 of the time) to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

Normal routine involves no exposure to blood, body fluid or tissue and as part of their employment, incumbents are not called upon to perform or assist in emergency care or first aid.

The incumbent has no occupational risk for exposure to communicable diseases.

Because the incumbent works within a healthcare setting, there may be occupational risk for exposure to hazardous medications or hazardous waste within the environment through receipt, transport, storage, preparation, dispensing, administration, cleaning and/or disposal of contaminated waste. The risk level of exposure may increase depending on the essential job duties of the role.

Are you ready to make a difference? Apply Today!

Ochsner Health does not consider an individual an applicant until they have formally applied to the open position on this careers website.

Individuals who reside in and will work from the state of Colorado are not eligible for remote work position.

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