Payor Relations NSA Specialist

Managed Care Payor Specialist

Lewisville, TX.

$75000-$90000 Range

Why Choose GMR? Global Medical Response (GMR) and its family of solutions are dedicated to delivering compassionate, quality medical care, primarily in the areas of emergency and patient relocation services. Here you'll embark in meaningful work that will make an impact on you and the customers we service. View our employees's stories on how we provide care to the world at www.AtaMomentsNotice.com.

JOB SUMMARY

The No Surprise Act Specialist works within the Managed Care Department to facilitate the steps required for the No Surprise Act Open Negotiation period. The ONP timelines must be adhered to in order to be eligible for additional reimbursement thru the NSA process. Will work closely with RCM, legal, and NSA project team to assure timely and accurate initiations and settlement reviews.

Essential Functions/Duties

• Responsible for the initiation of all claims eligible for Open Negotiation Process.
• Responsible for reviewing any rejected emails or issues with Open Negotiation to assure prompt resolution and correction within the ONP initiation period.
• Review all payor responses to Open Negotiation, entering data into Appian including copies of secure email.
• Negotiating within the established guidelines for settlements.
• Working with NSA legal, RCM, Managed Care, and NSA project team to assure smooth administration making recommendations for improved processes.
• Establishing and maintaining a good working relationship with internal and external customers.
• Regularly communicate with cross functional teams regarding payor behavior changes, updates and trends.
• Work with Managed Care team to identify potential payors for new agreements.
• Troubleshoot any ongoing enrollment issues with payors who have current or previous contracts.
• Liaison between Managed Care and RCM and NSA Legal.
• Other duties as assigned.

Qualifications:

Required Experience

• Fluent in English.
• 2+ Years experience working in a Managed Care, Payor Relations or other position responsible for negotiations with insurance companies.
• Strong computer skills with experience in various software packages, including Microsoft Suite and web-based applications.
• Knowledge of healthcare/medical billing/coding and insurance medical policy interpretation.
• Demonstrate strong follow through skills.
• Ability to work and adapt to a fast-paced environment and manage multiple projects- while maintaining a high level of attention to detail.
• Strong attention to detail and critical thinking skills.

Education

• High school diploma or equivalent required.

Skills:

• Requires strong problem-solving/critical thinking skills and attention to detail.
• Ability to work independently with limited supervision.
• Excellent written and verbal communication skills.
• Team Player.
• Negotiation with insurance carriers.

To learn more about GMR and how our values are at the core of our services and vital to how we approach care, visit www.GlobalMedicalResponse.com.

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Global Medical Response and its family of companies are an Equal Opportunity Employer, which includes supporting veterans and providing reasonable accommodations for individuals with a disability. Notice of Nondiscrimination: https://www.globalmedicalresponse.com/docs/site/non-discrimination

• Salary Range $75,000K-$90,000K
• Check out our careers site Benefits | GMR Careers to learn more about our comprehensive benefit options, which include medical, vision, dental, 401k, disability, FSA, HSA, EAP, vacation and paid time off.
• The application window for this position is anticipated to close on 3.11.2025