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Managed Health Specialist

Charlotte, NC, United States
Job ID: 103693
Job Family: Professional Services
Status: Full Time
Shift: Day
Detailed Shift and Schedule: M-F,
Remote Opportunity: Yes
Job Type: Regular
Department Name: 51011028341152-Payor Relations

Overview

Job Summary

Manages administration of the contract portfolio and the day-to-day relationships between the System and Managed Care Organizations (MCOs) within that portfolio. Coordinates the financial, legal, operation and other administrative processes between the Systems and MCOs that are necessary to secure new contracts and maintain the viability of existing contracts. Supports designated leaders as assigned.



Essential Functions
 

  • Manages administration of the assigned portion of the contract portfolio.
  • Maintains current detailed working knowledge of all assigned payor contracts, and manages all activities related to managed care contract administration and compliance including, but not limited to: Chargemaster Increases, Contract Rate Adjustments, Contract Critical Events, Entity and Contract Database, and MHR document distributions.
  • Creates and maintains electronic document database as well as original permanent files of all contract documents for all MCO contracts for the System.
  • Communicates and educates operational implementation of new contract terms that affect revenue cycle functions.
  • Manages the implementation process for all new or renegotiated managed care agreements.
  • Manages the secure distribution of confidential contract documents and communicates contract changes to executives, revenue cycle personnel and others within the System.
  • Monitors, reports, resolves and prevents operational issues related to existing managed care contracts. Routinely interacts with revenue cycle staff and MCO provider relations to resolve any trended or escalated operational issues that arise during the term of the contract.
  • Serves as advisor and point of contact for all revenue cycle personnel for trended managed care operational and administrative issues. Supports the designated teammates and Managed Health Resources (MHR) Provider Services in their operational roles.
  • Initiates and facilitates Joint Operating Committee (JOC) meetings with MCOs and facilitates internal meetings with revenue cycle staff for issue resolution and contract performance improvement. Coordinates all JOC and operational meetings, creates and distributes the agenda, creates performance reports and meeting minutes.
  • Reviews assigned payor websites and external information, staying current with regard to changes to payor policies and other initiatives.
  • Prepares clear, concise and focused internal communication/correspondence.
  • Determines where to gather data based on requests; performs analyses and methodology application, under supervision, noting sources and methods.

 

Physical Requirements
 

 

Performs most work under normal office conditions; may include sitting for long periods of time, standing, walking, using repetitive wrist/arm motion or lifting articles up to twenty-five pounds.



Education, Experience and Certifications
 

Associate's degree or equivalent experience required. Minimum two years experience in managed care contracting, operations, or patient financial services for large healthcare provider or managed care organization.