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Senior Payer Contract Specialist

2 weeks ago


Belleville, Ontario, Canada North American Dental Group Full time

Job Overview:

As a Senior Payer Contract Specialist, you will play a key role in the North American Dental Group's (NADG) Payer Relations team. Your primary responsibility will be to manage and negotiate contracts with dental insurance plans on behalf of The Professional Dental Alliance (PDA). This position requires a strong understanding of healthcare payer contracting, contract analysis, and financial analysis within a healthcare organization.

Responsibilities:

  • Analyze proposed rates by modeling and comparing reimbursement to determine contract value and potential revenue impact
  • Work closely with Accounting and Business Intelligence teams to procure data from available sources and develop reports for the Payer Relations department
  • Maintain accurate Participation Matrix by state and clinic
  • Maintain accurate TIN listing by state, practice, specialty
  • Maintain Leased, Tiered and Stacked Network Matrix
  • Proactively research payer policy changes that impact PDA/NADG
  • Continuously monitor contract performance and value, identifying new targets for renegotiation or biennial contract adjustment (COLA)
  • Assist with the entry of new rates into the Fee Schedule tables and perform regular maintenance of those tables

Requirements:

  • Bachelor's degree in a healthcare, business, finance, or a related field
  • 2-3 years of experience in provider relations, payer relations or financial analysis within a healthcare organization
  • Advanced Microsoft Office skills (Excel is a must), experience with Business Intelligence reporting preferred
  • Understanding of key performance metrics and performance reporting
  • High attention to detail with ability to analyze and summarize data