Philips Sales, Strategic Accounts Manager - Payer Relations, RespirTech (National) in United States of America - Home Based, Massachusetts

Position Title: Strategic Accounts Manager - Payer Relations

Department: Sales

Grade Level: 60

Position Status: Exempt

Reports To: Director of Sales – Strategic Accounts

Direct Reports : None

E-PHI Access: Full Access

Position Summary:

This position is responsible for establishing and maintaining contractual relationships with governmental and commercial health plans and payers.

Duties and Responsibilities:

  • Participate in the development and implementation of a Network Strategy to support the Company’s short and long-term strategic initiatives.

  • Proactively pursue contractual relationships with commercial and government insurers (payers) in accordance with the Company’s strategic initiatives, priorities, and ongoing business development activities.

  • Keep management informed on proposed reimbursement rates that are outside of the annually established average sale price (ASP).

  • Develop and articulate a value proposition to each payer in a manner that reflects the specific market variables while positively influencing contract terms and provisions.

  • Negotiate Letters of Agreement with specific payers to enable the company to serve patients when RespirTech is an out-of-network provider.

  • Identify and pursue opportunities to convert out-of-network status to in-network status with insurers to support recurring referral business.

  • Responsible for maintaining an effective, beneficial relationship between the Company and contracted insurers.

  • Maintain database of payer contacts and other relevant information

  • Contribute to an efficient contracting process that includes but is not limited to:

  • Completion of credentialing and re-credentialing documents in a complete and timely manner;

  • Timely review and summary of contract amendments;

  • Negotiation of rates deemed sufficient to support company goals;

  • Providing timely and succinct summary and status reports to company staff communication to management and identified staff of completed contracts and key terms and provisions;

  • Conducting all work in an organized, efficient manner.

  • Ensure contracts are installed / implemented within 48 hours of receipt of fully executed contract, in accordance with established policies and work processes.

  • Maintain an understanding of the contractual terms and provisions as they impact the authorization process and work collaboratively with internal staff to ensure each plan’s guidelines are understood and implemented.

  • Work directly with Insurance and Reimbursement teams to resolve any reimbursement or contractual issues.

  • Attend HIPAA training and other training sessions as they arise.

  • Perform additional duties as assigned.

Required Qualifications:

  • BA / BS or equivalent industry experience

  • Previous third party payer contracting experience

  • Demonstrated knowledge of the fundamentals of the insurance industry.

  • Excellent communication skills, both verbal and written

  • Demonstrates an ability for analytical and problem solving

  • Ability to organize and prioritize workload

  • Ability to work independently and as part of a team

  • Working knowledge of MS Word and Excel software

Physical Requirements of the Position:

Incumbent must be able to sit at computer desk in front of a PC Monitor for long periods of time. Position requires incumbent to use a PC, telephone, basic office equipment. Position requires ability to hear phone conversations and communicate clearly with all levels of internal and external customers. Must have ability to problem solve, work independently and/or with a team. 50% travel may be required to RespirTech service areas.

Acknowledgement:

I have read this job description and fully understand the requirements set forth therein. I understand that this is to be used as a guide and that I will be responsible for performing other duties as assigned. I further understand that this job description does not constitute an employment contract with Respiratory Technologies, Inc. (dba RespirTech), and that the job description may be revised and/or deviated from as needed. My employment with RespirTech remains “at will”.

In this role, you have the opportunity to:

The Strategic Account Manager for Payer Relations will be responsible for establishing and maintaining contractual relationships with governmental and commercial health plans and payers.

You are responsible for:

  • Participate in the development and implementation of a Network Strategy to support the Company’s short and long-term strategic initiatives.

  • Proactively pursue contractual relationships with commercial and government insurers (payers) in accordance with the Company’s strategic initiatives, priorities, and ongoing business development activities.

  • Keep management informed on proposed reimbursement rates that are outside of the annually established average sale price (ASP).

  • Develop and articulate a value proposition to each payer in a manner that reflects the specific market variables while positively influencing contract terms and provisions.

  • Negotiate Letters of Agreement with specific payers to enable the company to serve patients when RespirTech is an out-of-network provider.

  • Identify and pursue opportunities to convert out-of-network status to in-network status with insurers to support recurring referral business.

  • Responsible for maintaining an effective, beneficial relationship between the Company and contracted insurers.

  • Maintain database of payer contacts and other relevant information

  • Contribute to an efficient contracting process that includes but is not limited to:

  • Completion of credentialing and re-credentialing documents in a complete and timely manner;

  • Timely review and summary of contract amendments;

  • Negotiation of rates deemed sufficient to support company goals;

  • Providing timely and succinct summary and status reports to company staff communication to management and identified staff of completed contracts and key terms and provisions;

  • Conducting all work in an organized, efficient manner.

  • Ensure contracts are installed / implemented within 48 hours of receipt of fully executed contract, in accordance with established policies and work processes.

  • Maintain an understanding of the contractual terms and provisions as they impact the authorization process and work collaboratively with internal staff to ensure each plan’s guidelines are understood and implemented.

  • Work directly with Insurance and Reimbursement teams to resolve any reimbursement or contractual issues.

  • Attend HIPAA training and other training sessions as they arise.

  • Perform additional duties as assigned.

You are a part of:

  • The Strategic Accounts Sales Team for RespirTech. You will report to the Sales Director for Strategic Accounts, and be solely responsible for driving contracting efforts between RespirTech and our third party payers.

To succeed in this role, you should have the following skills and experience:

  • BA / BS or equivalent industry experience

  • A minimum of 3 years of experience with third party payer contracting

  • Demonstrated knowledge of the fundamentals of the insurance industry.

  • Excellent communication skills, both verbal and written

  • Demonstrates an ability for analytical and problem solving

  • Ability to organize and prioritize workload

  • Ability to work independently and as part of a team

  • Working knowledge of MS Word and Excel softwareIn return, we offer you:The Strategic Account Manager role will give you the opportunity to take your career to the next level in a world-leading organization that is backed by a stable 120-year legacy of innovation. Here, you’ll go as far and as wide as you aspire. We make sure of it through support of a formal development planning process, as well as countless opportunities to expand your knowledge and skill set through resources such as the Learning@Philips program, tuition reimbursement and/or mentor relationships.Why should you join Philips?Working at Philips is more than a job. It’s a calling to create a healthier society through meaningful work, focused on improving 3 billion lives a year by delivering innovative solutions across the health continuum at http://www.philips.com/b-dam/corporate/corporateblog/2016/PhilipsChronicDisease_5.jpg . Our people experience a variety of unexpected moments when their lives and careers come together in meaningful ways. Learn more by watching this video .To find out more about what it’s like working for Philips at a personal level, visit the Working at Philips page at http://www.philips.com/a-w/careers/healthtech/working-at-philips/working-at-philips.html on our career website, where you can read stories from our employee blog at http://www.usa.philips.com/a-w/our-people/life-at-philips.html . Once there, you can also learn about our recruitment process at http://www.philips.com/a-w/careers/healthtech/philips-recruitment-process.html , or find answers to some of the frequently asked questions at http://www.philips.com/a-w/careers/healthtech/faq.html .Philips is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex (including pregnancy), sexual orientation, gender identity, national origin, genetic information, creed, citizenship, disability, protected veteran or marital status.As an equal opportunity employer, Philips is committed to a diverse workforce. In order to ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veterans' Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants that require accommodation in the job application process may contact 888-367-7223, option 5, for assistance.No Sponsorship offered"US work authorization is a precondition of employment. The company will not consider candidates who require sponsorship for a work-authorized visa."

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