Emp Status

Regular Full time

Work Shift

Compensation Range

The base pay scale for this position is $112,000.00 - $170,875.00. In addition, this position will be eligible for additional benefits consistent with the role. The salary of the finalist selected for this role will be determined based on various factors, including but not limited to: scope of role, level of experience, education, accomplishments, internal equity, budget, and subject to Fair Market Value evaluation. The hiring range listed is a good faith determination of potential compensation at the time of this job advertisement and may be modified in the future.

What you will be doing

JOB DESCRIPTION

Managed Care Manager job description

Reporting to the Director of Payer Relations, the Managed Care Manager will play a critical support role in facilitating engagement between Insurance Payers, Revenue Cycle, internal and external billing departments, and various other stakeholders. This position will have particular focus in triaging systemic claims issues to assess the full scope and impact while identifying root cause allowing for successful escalation and resolution. The Managed Care Manager will rely on interpretation of both Payer contracts and polices, along with an understanding of Accounts Receivable, to ensure that issues presented by Revenue Cycle are addressed and resolved in a timely manner.

RESPONSIBILITIES:

• Maintain knowledge of Managed Care contracts and Payers’ payment rules and policies.
• Work closely with other members of the Managed Care team, Revenue Cycle, and/or professional billing entities to size and resolve identified Payer issues impacting Accounts Receivable and contract performance for both PHO providers and facilities.
• Responsible for ensuring reports and updates (i.e., A/R denials, project status, etc.) are disseminated to departmental staff. 
• Escalate issues as necessary to Payer contacts for resolution with engagement and input from the Managed Care contracting team as needed.  Recommend escalation as appropriate to senior management.
• Additional responsibilities as required to accomplish departmental goals.

EXPERIENCE, COMPETENCIES, AND PERSONAL CHARACTERISTICS: 

•    Experience (minimum 3+ years) with Payer or provider contracting and/or Revenue Cycle management.
•    Experience with EPIC or other comparable EMR systems preferred.
•    Possesses knowledge of Payer policies and resolution processes.
•    Knowledge of the healthcare industry and Payer reimbursement methodologies (both hospital and physician).
•    Ability to work independently and collaboratively to solve complex problems.
•    Excellent verbal and written communication skills.
•    Excellent organizational and multi-tasking skills.

EDUCATION:

•   Bachelor’s degree in health or business administration, economics or related subject is required.  Masters preferred.