Payor Coordinator Analyst - Value Based Care Contracts - Southwestern Health Resources

Payor Coordinator Analyst – Value Based Care Contracts - Southwestern Health Resources

Southwestern Health Resources is looking for a highly skilled Payor Coordinator Analyst.  Is that you?

Work Location: Remote: Southwestern Health Resources Headquarters, Hybrid: 1601 Lyndon B. Johnson Freeway, Farmers Branch, TX 75234.

Work Hours: Full Time Days (8:00am-5:00pm) for 40 hrs/week (remote work allowed at manager's discretion)

 Department Highlights:

• Hybrid Position
• Gain a sense of accomplishment by contributing to a teamwork environment.
• Receive excellent mentorship, comprehensive training, and dedicated leadership resources.
• Contribute and work on a cross functional team

What You Will Do: 

Contract Management Support: Value – Based Care Contracts

While this role is focused heavily on value-based care contracts, the PCA will support the other managed care functions as needed. 

Review and interpret payor contracts to understand contract language, financial incentives, and other relevant items of the contract.
Assist with maintaining contract language key terms by payor tracking grid.
Prepare routing documents for new contracts and amendments.
Review and redline low-level amendments (e.g., term extensions, quality measure updates) and exhibits
Complete and distribute new contract orientation forms and communications to internal stakeholders.
Maintain organized records of contract status, amendments, and stakeholder communications.
30%
Project Management:
Maintain project tracker by payor (e.g., Aetna, BCBSTX, Cigna, UHC) and monitor project status.
Participate in payor calls, identify trends, work with payors to resolve issues and document outcomes.
Escalate unresolved issues to appropriate parties and follow through to resolution.
Maintain and update project trackers, ensuring alignment with internal stakeholders and timelines.

30%
Contract Operations ?�� New Contracts and Amendments
Interpret and communicate contract or contract changes to internal stakeholders.
Collaborate with analysts to assess the financial implications of a new contract or contract amendments for internal stakeholders.
Notify payors of significant impacts within required timeframes and monitor resolution status.
Document and communicate new contract and contract changes and outcomes to relevant internal teams.

10%
Managed Care Projects & Provider/Payor Queries
Support cross-functional managed care initiatives and respond to provider or payor-related queries.
Communicate with providers, payors, internal stakeholders (quality, medical economics, finance), and others to resolve issues and improve processes.
Collect, organize, and present data in a clear and actionable format.
Provide timely updates and final reports to requesting departments or leadership.
Ensure all project documentation is complete, accurate, and accessible.

20%
Committee Participation
Represent the Market and Payor Relations team in internal and external meetings, committees, and workgroups.
Actively participate in discussions, share insights, and contribute to strategic planning efforts.
Build and maintain strong relationships with providers, payors and internal departments to support collaborative problem-solving. 10%

What You Need: 

Education
Bachelor's Degree Business or Healthcare 4 Years Req Or
Master's Degree Business or Healthcare Pref

Experience
4 Years 4 Years of Experience in managed care, payor relations, or healthcare operations Req