MedStar Southern Maryland Hospital Center

Managed Care Payment Integrity Liaison

MedStar Southern Maryland Hospital Center • $65K — $117K *
Columbia, MD 21044In-Person
Healthcare
5 - 7 years of experience
Reposted 3 days ago
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Job Overview by Ladders

Qualifications

  • Bachelor's degree in Healthcare Administration, Finance, Business, or related field, or Associate's degree with 12-15 years of relevant experience
  • 5-7 years of experience in managed care operations and/or tertiary hospital revenue cycle
  • Deep understanding of managed care reimbursement models (e.g., DRG, APC, per diem)
  • Strong knowledge of denials, underpayments, appeals workflows, billing compliance, and payer policies
  • Experience with managed care plans and commercial payer negotiations preferred
  • Familiarity with payer portals and contract modeling tools preferred
  • Familiarity with Maryland's Health Services Cost Review Commission and EPIC preferred

Responsibilities

  • Lead investigations into denial trends and payment discrepancies related to managed care contracts
  • Update payer-specific escalation logs with relevant, timely, and informative data
  • Collaborate with payer representatives to resolve systemic underpayments and denials
  • Track and review updates from payers, maintaining a comprehensive database of policy changes
  • Analyze operational, financial, and compliance impacts of new or revised payer policies and communicate with stakeholders
  • Proactively identify and address operational issues with payers and gather feedback from Revenue Cycle teams
  • Participate actively in all payer meetings focused on claim issue resolution

Benefits

  • Collaborative work environment with internal staff and external payers
  • Opportunity to develop and maintain denial prevention strategies
  • Access to comprehensive training on managed care reimbursement models
  • Engagement with a variety of stakeholders, enhancing professional relationships
  • Possibility of advancing within a dynamic healthcare organization
Full Job Description
General Summary of Position
The Managed Care Payment Integrity Associate will bridge the gap between managed care and revenue cycle ensuring accurate reimbursement and minimizing payment delays. This position focuses heavily on analyzing resolving and preventing denials and underpayments from Commercial Managed Medicare and Managed Medicaid payers. In addition this Associate will have the responsibility of tracking payer policies and informing key stakeholders of the operational and/or financial impact of any change.

Primary Duties and Responsibilities

  • Leads investigations into denial trends and payment discrepancies related to managed care contracts. Escalates claims and hold payers accountable for resolution.
  • Updates payer-specific escalation logs with relevant timely and informative data.
  • Collaborates with payer representatives to resolve systemic underpayments and denials. Develops and maintains payer-specific denial prevention strategies.
  • Tracks and reviews updates from payers including policy bulletins coverage determinations medical necessity guidelines coding updates and reimbursement rule changes. Maintains a comprehensive database of policy changes with effective dates impacted services and required organizational actions.
  • Analyzes the potential operational financial and compliance impacts of new or revised policies and communicates appropriately to key stakeholders.
  • Proactively identifies and addresses operational issues with payers. Gathers feedback from Revenue Cycle teams regarding contract implementation and performance.
  • Actively participates in all payer meetings focused on claim issue resolution.
  • Maintains effective working relationships and communications with internal staff MedStar Health leaders and external managed care payers.

Minimal Qualifications
Education
  • Bachelor's degree in Healthcare Administration Finance Business or related field required or
  • Associate's degree with 12-15 years of relevant experience required

Experience
  • 5-7 years Experience in both managed care operations and/or tertiary hospital revenue cycle. required and
  • Deep understanding of managed care reimbursement models (DRG APC per diem etc.) required and
  • Strong working knowledge of denials underpayments and appeals workflows as well as billing compliance and payer policies required and
  • Experience with all forms of Managed Care plans and commercial payer negotiations. preferred and
  • Familiarity with payer portals and contract modeling tools. preferred and
  • Familiarity with Maryland's Health Services Cost Review Commission. preferred and
  • Familiarity with EPIC. preferred

Knowledge Skills and Abilities
  • Hospital billing systems
  • Communication collaboration and critical thinking skills
  • Microsoft Excel

This position has a hiring range of

USD $65,062.00 - USD $117,291.00 /Yr.

About MedStar Southern Maryland Hospital Center

MedStar Southern Maryland Hospital Center is a medical facility located in Clinton, Maryland. It is a 192-bed acute care hospital that provides a range of services including emergency care, cardiology, cancer care, orthopedics, and women's health. The hospital is part of the MedStar Health system, which is the largest healthcare provider in Maryland and the Washington, D.C. region. MedStar Southern Maryland Hospital Center is committed to providing high-quality, compassionate care to its patients and improving the health of the communities it serves.
Learn more about MedStar Southern Maryland Hospital Center
Size
1,200 employees
Industry
Healthcare
* Ladders Estimates

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