Payer Relations Manager

Job Title: Payer Relations Manager

Location: Remote / Austin, TX

Position Type: Full-time

About Us: The National Infusion Center Association (NICA) is a non-profit 501(c)(6) trade association dedicated to advancing the interests of community-based, non-hospital infusion centers.

Position Overview: NICA is seeking a Payer Relations Manager to join the advocacy team. In this role, the Payer Relations Manager will work directly with infusion providers to effectively advocate for their interests when dealing with insurance companies. This individual will play a crucial role in addressing challenges related to prior authorization, utilization management, and claim payments, while strategically building and maintaining strong relationships with key decision-makers at insurance companies. The ideal candidate will have a blend of negotiation skills, problem-solving abilities, and deep knowledge of insurance processes, with a passion for delivering member value through advocacy.

Key Responsibilities:

1. Advocacy and Negotiation:
   • Advocate for members when issues arise with insurance companies and work to resolve challenges related to prior authorization, utilization management, and claim payments.
   • Educate insurance companies through verbal and written communication about the value of working with the organization and the benefits of having mutually reliable relationships with community-based, non-hospital infusion centers.
   • Serve as a key negotiator to unlock unpaid, delayed, or denied claims for members and improve payment processing efficiencies.
2. Insurance Company Relationship Building:
   • Establish and cultivate relationships with key decision-makers at insurance companies to represent the interests of members, foster ongoing communication, and advocate for the recognition of the organization's accreditation program, particularly in addressing challenges related to prior authorization and claim payment.
3. Strategic Collaboration:
   • Work closely with Member Relations, Clinical Education, and MarCom to identify key challenges facing members, develop strategies to address them, and communicate the value of NICA’s payer relations capabilities to members.
   • Collaborate to develop and deliver educational content and materials related to payer policies, practices, and processes.
   • Partner with internal teams to ensure member communications and resources are aligned with the organization’s advocacy and negotiation efforts.
4. Pain Point Identification and Resolution:
   • Collect and analyze data related to member challenges with payer policies, practices, and claim payments to inform negotiation strategies with insurance companies.
   • Develop actionable insights and recommendations based on current member issues, using those insights to advocate for improvements in insurance company policies, processes, and practices.
5. Metrics and Reporting:
   • Track and report on the success of engagements with insurance companies, including the number of relationships built, progress on prior authorization and utilization management improvements, and the total value of claim payments unlocked for members.
   • Monitor and report on the effectiveness of strategic initiatives aimed at reducing member pain points related to payer policies/processes.
6. Industry Representation and Education:
   • Represent the organization at industry events and forums to stay updated on trends and practices related to insurance policies and claim payments.
   • Collaborate cross-functionally to create educational resources that inform internal stakeholders and insurance companies about best practices in optimizing health outcomes while unlocking cost-savings.

Qualifications:

Required Experience:

• Bachelor’s degree
• Direct experience working within or with insurance companies.
• Knowledge of insurance processes, including prior authorization, utilization management, claims payment, and overall payer/provider interactions.
• Strong verbal and written communication and negotiation skills, with the ability to build relationships and advocate effectively for members.
• Strong attention to detail as well as organizational and time management skills
• Comfortable working remotely and independently as well as in a team environment

Preferred Experience:

• Experience with billing and coding---or processing---medical claims.
• Direct experience working within a healthcare provider organization, particularly revenue cycle, insurance issues, or payer contracts.

Working Conditions

• Flexible hours
• Minimum 25% travel within the United States (including to the national office in Austin, TX) with multi-day overnight stays
• Availability to work occasional nights and weekends to support events, committee meetings, etc.