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INSURANCE ADMINISTRATOR(Job Id 19269)
Description
Covenant HealthCare
Summary:
To develop, maintain, implement and monitor contractual relationships with third party Insurance Payors on behalf of HFHS and its business units.
Responsibilities:
PRINCIPAL DUTIES AND RESPONSIBILITIES: 1. Under supervision of Director or Managed Care Contracting, works directly with Payors to negotiate contractual provisions and rates on behalf of HFHS Hospitals, Medical Group, Behavioral Health Services and other business units. 2. Independently evaluate and analyze contract proposals including completing initial proposal responses and reviewing/revising contract language and operational requirements. Reviews contracts with in house legal-council and works through contract revisions with Payors. 3. Routinely monitor current contracts for appropriate rate structure, contract terms and annual renewals and/or re-negotiations and compliance with industry standards and guidelines. 4. Monitor marketplace for new contracting opportunities and make recommendations of changes to enhance HFHS contract portfolio. 5. Coordinate implementation of Payor arrangements and provide ongoing education and support throughout HFHS. 6. Collect and communicate relevant contractual requirements and issues to internal customers such as Utilization Management, Finance, Patient Billing, Administration, Legal, etc. Information includes; payor relationships, operational requirements and contract terms. 7. Maintain comprehensive files of HFHS contractual relationships and update contract information in the contract database. 8. Maintain contract summaries on HFHS website (Henry). 9. Act as liaison between HFHS and Payors on contracting and operational issues, i.e. billing, utilization review, credentialing site visits, notification of site closures or new services. 10.Coordinate facility credentialing and re-credentialing. 11.Perform other duties as assigned.
EDUCATION/EXPERIENCE REQUIRED: • Bachelors Degree in Business, Healthcare or related field. • Minimum of four (4) years in the healthcare industry in a professional capacity. • Knowledge of managed care organizations and integrated health systems. • Previous contracting, provider relations and/or provider reimbursement experience. • Comprehensive project management abilities. • Excellent oral and written communication and presentation skills. • Excellent organizational skills and ability to manage multiple projects simultaneously. • Excellent interpersonal skills and ability to develop effective working relationship with both internal and external customers. • Strong negotiation skills. • Understanding of legal, business, and insurance operations principles. Proficient in Microsoft Word. PHYSICAL DEMANDS/WORKING CONDITIONS: • Normal office environment with minimal exposure to noise, dust, or extreme temperatures.
Full Time
Wholesale
$58k-75k (estimate)
03/24/2024
07/20/2024
covenanthealthcare.com
SAGINAW, MI
100 - 200
2000
SHELLY REDLINGER
$10M - $50M
Wholesale
Covenant Occupational Health is a primary/secondary education company based out of 2919 Wilder Rd, Bay City, Michigan, United States.
The job skills required for INSURANCE ADMINISTRATOR include Billing, Written Communication, Presentation, Organizational Skills, Managed Care, etc. Having related job skills and expertise will give you an advantage when applying to be an INSURANCE ADMINISTRATOR. That makes you unique and can impact how much salary you can get paid. Below are job openings related to skills required by INSURANCE ADMINISTRATOR. Select any job title you are interested in and start to search job requirements.
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