Full Job Description
Summary:
The Managed Care Payer Relations Manager manages the day- to- day activities of the payer relations function. Develops, manages, and sustains relationship with managed care payers. Serves as a resource, answering questions and providing information about network procedures or contracts. Reviews billings and claims payments according to managed care contracts.
Responsibilities:
1. Payer Relations- Manages relationships and represents UNC HCS as a primary point of contact and liaison in various managed care contractual relationships, handling communication, contract compliance, problem resolution, legal issues, etc.
2. Managed Care Analysis- Identifies management information needs; researches and analyzes data to provide necessary information to leadership positions. Analyzes financial, contractual, and operational issues related to contracted payers. Reports to Health Care System leadership the financial impact of billing and claims payment issues according to managed care contracts. Verifies the accurate and on-time loading of professional fee schedules by payers and in the UNC HCS Contract Manager tool.
3. Leading People- Leads people toward meeting the organization's vision, mission, and goals. Provides an inclusive workplace that fosters the development of others, facilitates cooperation and teamwork, and supports constructive resolution of conflicts. Treats sensitive or confidential information appropriately. Works to improve and reinforce performance of others. Delegates assignments, clarifies expectations and holds others accountable for achieving results related to their area of responsibility. Encourages workforce engagement by building a commitment to excellence. Works collaboratively toward solutions that accomplish organizational objectives.
Other Information
Other information:
Education Requirements:
• Bachelor's degree in relevant field
Licensure/Certification Requirements:
Professional Experience Requirements:
• Requires five (5) years of experience with managed care contracts and provider relations. If Associate's degree, requires nine (9) years of experience with managed care contracts and provider relations.
Knowledge/Skills/and Abilities Requirements:
Job Details
Legal Employer: NC Health
Entity: Shared Services
Organization Unit: Managed Care
Work Type: Full Time
Standard Hours Per Week: 40.00
Salary Range: Pay offers are determined by experience and internal equity
Work Assignment Type: Hybrid
Work Schedule: Day Job
Location of Job: US:NC:Morrisville
Exempt From Overtime: Exempt: Yes
This position is employed by NC Health (Rex Healthcare, Inc., d/b/a NC Health), a private, fully-owned subsidiary of UNC Health Care System, in a department that provides shared services to operations across UNC Health Care; except that, if you are currently a UNCHCS State employee already working in a designated shared services department, you may remain a UNCHCS State employee if selected for this job.
