1 Managed Care Contract Liaison- Managed Care Job in Lakeland, FL

SORT BY

SET JOB ALERT

OFF

Details...

Managed Care Contract Liaison- Managed Care

Lakeland Regional Health

Lakeland, FL | Full Time

$56k-72k (estimate)

3 Weeks Ago

Managed Care Contract Liaison- Managed Care

$56k-72k (estimate)

Full Time 3 Weeks Ago

Save

Lakeland Regional Health is Hiring a Managed Care Contract Liaison- Managed Care Near Lakeland, FL

Position Information

Work Type: Active - Benefit Eligible and Accrues Time Off
Exempt: No

Work Schedule: Monday - Friday
Work Hours per Biweekly Pay Period:

Shift Time:
Location: 210 Office Building, US:FL: Lakeland

Position Summary

Summary:
Serves as managed care operations liaison, and acts as first level resource for resolution of contracting and provider enrollment issues, to include Single Case Agreements. Maintains contract/contracting files, and enrolls/disenrolls providers within the EPIC system and performs related audits. Maintains departmental tools, databases, and Intranet/Internet sites. Communicates effectively with internal/external customers, and contracted provider enrollment vendor. Escalates enrollment and payer issues for review, and obtains necessary leadership direction.

Position Details

Detailed responsibilities:

People at The Heart of All We Do

Fosters an inclusive and engaged environment through teamwork and collaboration.

Ensures patients and families have the best possible experiences across the continuum of care.
Communicates appropriately with patients, families, team members, and our community in a manner that treasures all people as uniquely created.

Safety And Performance Improvement

Behaves in a mindful manner focused on self, patient, visitor, and team safety.
Demonstrates accountability and commitment to quality work.
Participates actively in process improvement and adoption of standard work.

Stewardship
Demonstrates responsible use of LRH's resources including people, finances, equipment and facilities.
Knows and adheres to organizational and department policies and procedures.

Standard Work Duties: Managed Care Contract Liaison
Works closely with departmental management and staff on specific payor issue resolution activity, high dollar claims/settlements or other major projects. Performs first level root cause to assist internal/external customers. Coordinates single case agreements (SCA) and post service discount (PSD) agreements within approved rate parameters. Can perform analysis and follow up with minimal oversight. Escalates effectively.
Serves as initial point-of-contact regarding Provider Enrollment, to include interface with and behalf of subcontracted vendor. Reviews and audits Payor Directories on a quarterly basis; assists with payor educational audits. Maintains provider status in EPIC on a payer-specific basis, to include initial activation and termination. Works EPIC projects as needed, to include Directory audits.
Maintains quality control of contracts/document management systems, runs reports and ensures timeliness of contract updates. Coordinates all notices and tracking of such to payors of charge master updates, rate changes. Handles direct contact with payor representatives to ensure systematic updates are received and understood, and will coordinate service-line specific payer surveys as necessary. Maintains the MediTract system, and performs quarterly maintenance on hyperlinks on Managed Care page (Member ID Cards, Provider Manuals, Client Lists).
Maintains Managed Care's Intranet and Internet site tools and payor database, contract matrices, and profiles, making updates as needed within departmental guidelines for timeliness. Communicates as needed to key internal customers, to include Marketing.
Maintains contract profile by updating and/or adding new plans and contracted rates accurately through in depth understanding of contract fee terms.
Ensures administrative needs of department are met, including, maintenance of departmental Emails and mail. Maintains and updates the department SOP manual, and serves as backup timekeeper.
Maintains positive working relationship with peers, and external and internal customers. Meets department standards for customer responsiveness, and work/project deadlines.
Organizes job functions and work assignments to be able to effectively complete assignments within established time frames.

Qualifications & Experience

Education:
Essential:

High School or Equivalent

Other information:
Experience Essential:

Demonstrated knowledge patient accounting, revenue cycle, finance, or provider operations experience with understanding of billing and payment methods
Demonstrated knowledge of payer/provider contracts and related document management
Demonstrated knowledge of credentialing/enrollment processes, with ability to identify and address enrollment issues that impact provider revenue cycle and delegation of credentialing

Experience Preferred:

Demonstrated knowledge of credentialing/enrollment processes, with ability to identify and address enrollment issues that impact provider revenue cycle and delegation of credentialing lick here to enter text.
Understanding of how Provider Enrollment and Delegation of Credentialing impact payment of claims