F/T Coordinator, Managed Care
Payer Strategy & Contracting
In this role you will work closely with the Sr. Director and responsibilities will include managing the overall relationships with the managed care companies. This may include assisting in contracting, rate analysis, maintenance of rate sheets, and overall trouble-shooting when issues arise both internally and externally.
In this role, you will work closely with the Sr. Director to address claims payment issues from payers.
You will be involved in all aspects of underpayments/rate appeals, including identifying variances, identifying and resolving root causes of claims issues, identifying trends, tracking payment, working directly with the payers on these issues and interacting daily with Patient Accounting.
You will be responsible for leading the Joint Operating Committee meetings. This will include developing agendas, preparing summaries and reporting on results and production.
Responsibilities include preparing weekly, monthly and ad hoc reports on rate appeal activity and resolution.
The individual will show a demonstrated ability to interact with all levels of the organization. Additionally, the individual will also interact with payer contacts at all levels.
The individual will keep appraised on payer payment rules and administrative policies.
The successful candidate will possess a Bachelors Degree with a minimum of 2 years’ experience in hospital or managed care setting. Previous hospital, payer or managed care insurance experience required. Must be knowledgeable in facility claims and reimbursement methodologies as well as overall managed care concepts.
Detail orientated individual with the ability handle multiple project simultaneously while working with all levels and departments of the organization is essential. The individual must possess a willingness to learn and grow within the Payer Strategy department.
Strong computer and IT skills required with proficiency with Excel and Word a must. Epic experience preferred, but not required.