Payer Relations Operations, Mgr. (FT. 40hrs) at BioReference Labs in Elmwood Park, New Jersey

Job Description:

This is an exciting time to join our dynamic organization. OPKO Health is a diversified healthcare company that seeks to establish industry-leading positions in large, rapidly growing markets, including pharmaceuticals, diagnostics, and biologics. OPKO's diagnostics business includes BioReference Laboratories, the nation's third-largest and fastest growing clinical laboratory over the last 35 years, which provides diagnostic testing to physician offices, hospitals, and clinics, among others, and GeneDx, a rapidly growing genetics and genomics laboratory that applies cutting edge technologies to make efficient clinical diagnostic testing and interpretation available for individuals with rare and common genetic conditions. Come join our team and become part of something big, by making our patients and customers the highest priority.

We are looking for a Payer Relations Operations Manager(40 hours per week) in ourElmwood Park, NJ location.

Schedule: Monday to Friday from 9:00am-5:30pm

SUMMARY:

BioReference Laboratories is dedicated to improving lives through better healthcare, better service, and better science. It is also a primary goal of BioReference Laboratories to offer providers a single source for all their laboratory-testing needs in both the primary and specialty health care segments. A critical component to meeting this goal is through a strong relationship with providers, patients, and managed care organizations. Payer Relations Operations Manager is the departmental leader responsible for the administrative management of the Payer Relations staff that analyze, maintain, and support the field-based Payer Relations Managers and health plan payer relationships nationwide.

PRIMARY RESPONSIBILITIES AND ESSENTIAL DUTIES:

Reporting to the VP of Payer Relations, the Payer Relations Operations Manager is responsible for managing the administrative departmental activities of Payer Relations in compliance with all regulatory requirements, and helping to identify and evaluate operational opportunities and manage risks related to health plan administration, all in accordance with the core values of BioReference Laboratories.

• Works with the VP of Payer Relations and Regional Payer Relations Managers to support and maintain the administrative aspects of health plan contracts.


• Manage processes inter-departmentally to keep health plan marketing and financial information current.


• Train staff on related company initiatives to support contract administration for managed care agreements.


• Serve as a leader providing valuable insight into solving an array of strategic and business challenges related to managed care and reimbursement.


• Provide education and training to staff across all silos regarding all aspects of managed care.


• Manage reporting of payer-required performance metrics and quality indicators.


• Interface with contracted national managed care organizations and payers to support exceptional customer service and responsiveness.


• Manage all administrative staff including payer relations analysists, coordinators and clerical employees.


• Collaborate and coordinate with sales leadership and marketing staff.


• Continually analyze payer data to determine trends for financial accuracy.


• Work effectively with individuals across multiple departments throughout the organization.


• Embrace, embody and represent the BioReference Laboratories company culture at all times to external and internal constituents.

REQUIRED SKILLS:

• Ability to manage and staff in accordance with company’s goals and core values


• Credentialing experience


• Health plan policy review experience


• Revenue Cycle experience


• Comfortable communicating at the executive level (CEO, COO, CFO, EVP, SVP)


• Keen understanding of managed care and health plan operations including reimbursement in the clinical laboratory space


• Ability to work independently, communicate proactively, manage multiple projects and prioritize daily tasks while managing critical deadlines


• Excellent knowledge of the independent clinical laboratory specialty


• Excellent customer service skills


• Superior listening and problem solving skills


• Ability to handle sensitive information and maintain a very high level of confidentiality


• Possess a very positive attitude and an understanding of the dynamics involved with organizational growth and change

• Must be very proficient with all Microsoft Office products

• Ability to develop and utilize cross-functional relationships to facilitate the accomplishment of work goals and objectives


• Advanced presentation skills and business acumen a necessity


• Ability to work effectively with minimal direction from, or interface with, manager


• Strong administrative skills and sophistication to manage business in complex environments


• Demonstrate the values of the company by acting with integrity, respect and trust


• Limited travel may be required (<10%)

Required Education & Experience

• S. in Business Administration, Management, Accounting, Finance or equivalent experience.


• 4+ years of experience as a manager or director in the health care provider setting, preferably within a reference lab setting.


• 4+ years with health care claims processing, adjudication, and appeals.

BioReference is an Equal Opportunity Employer**