Are you an internal caregiver, student, or contingent worker/agency worker at UMass Memorial Health? CLICK HERE to apply through your Workday account.Exemption Status:Exempt
Hiring Range:$71,780.80 - $129,230.40
Please note that the final offer may vary within this range based on a candidate's
experience, skills, qualifications, and internal equity considerations.
Schedule Details:Monday through Friday
Scheduled Hours:8:30AM - 5:00PM
Shift:1 - Day Shift, 8 Hours (United States of America)
Hours:40
Cost Center:99940 - 5876 Payer Contracting
This position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process.
Responsible for managed care operations activities for UMass Memorial Medical Center and UMass Memorial Medical Group (collectively "UMMHC"). Acts as primary liaison with managed care plans relative to the research and resolution of claims payment discrepancies.
Major Responsibilities:- Responsible for resolution of operational issues impacting claims payment, including billing, patient registration, referral and authorization, credentialing, and provider set up issues. Works with internal and external customers to improve workflow and resolve payment discrepancies.
- Researches UMMHC contractual requirements and operational policies to ensure health plan compliance with negotiated financial arrangements. Coordinates efforts with management within Contracting and Provider Relations.
- Provides effective direction, guidance, and leadership in conducting monthly claims meetings and fosters effective teamwork in problem resolution.
- Coordinates the assignment of tasks and helps resolve technical and operational problems. Evaluates the impact of solutions to ensure goals are achieved.
- Participates in performance improvement initiatives and demonstrates the use of quality improvement in daily operations.
- Ensures compliance with regulatory agencies such as Joint Commission, DPH, etc. Develops and maintains procedures necessary to meet regulatory requirements.
- Ensures that duties comply with hospital established policies, quality assurance programs, safety, and infection control policies and procedures.
Position Qualifications:- Bachelor's degree or equivalent in Business Administration, Health Care Management or related discipline.
- Minimum of 5-7 years of experience in a managed care setting, with a thorough understanding of managed care plan operations, is required.
- A thorough understanding of clinical operations, hospital and physician billing and health care terminology, and managed care policy required.
- Excellent verbal and written communication skills.
- Former managerial experience is preferred.
