Overview:
Position is responsible for working with various internal and external customers regarding contract payor terms, policy/procedure updates, payor administration, variances/contract modifications, pricing updates, as well as anything that has an operational impact on the organization. Strong analytical skills needed to compile and analyze data including: managed care denials/underpayment/ overpayment identification and resolution, contract modeling and evaluation, filing appeals as well as aiding in decision support reporting. This position is responsible for day-to-day oversight of the contract compliance, payor relationships, co-ordination of payer onsite meetings and cross training with Provider Enrollment Specialist for credentialing and re-credentialing duties. Must work within contract language and have an understanding of healthcare reimbursement methodologies and language. Majority of time will be spent working within Microsoft Excel, performing data analysis, tracking, trending and research. Will also work with Contract Modeling software.

Duties:

• Develops and manages contract variance reporting, account research and evaluation for correct payments. Variance reporting should be maintained on 1-week intervals for up-to-date reporting. In some cases daily reporting will be needed.
• Leads in the identification, review and collection of contractual variances discovered through variance reporting within five days of discovery. Follow-up at appropriate intervals to ensure payor investigation and compliance. (10,30,45,60 day intervals)
• Denials management. Researches and accurately ascertains whether denials by Payors are appropriate and if not, must appeal accounts according to Payor policies and procedures in order to overturn denial decisions. Must also track overturned denials, perform follow-up on appeals and accurately record overturned, additional dollars obtained.
• Acts as the liaison between contracted payors and internal departments for escalated contractual and reimbursement issues, including but not limited to, managing quarterly payor meetings, payor updates and communications and on contract compliance issues and payor responses.
• Responsible for the scan and upload of all hospital and physician contracts and fee schedules into DocuShare or other appropriate contract management system.
• Aid in any Decision Support data assembly and analysis as needed.
• Responsible for maintaining Payor contract contact listing with contract specific timeframes.
• Gatekeeper for Managed care shared folders, documentation maintenance. Will aid in the creation of fee schedule matrix and or database that houses Managed Care Payer fee schedules for CVMC and CVMG.
• Liaison between Managed Care Director and CVMG, for Managed Care contract assistance and direction.
• Provides backup to Managed Care Provider Enrollment Specialist.
• Manage administrative duties for team as needed, including supply management, reference management, and liaison between department and environmental services.

Required Education:

Associate’s degree from an accredited college or a minimum of four years’ experience with managed care contracting or payor relations. Must possess a strong understanding of managed care operations/reimbursement methodologies. Strong to advanced Microsoft Excel and analytical skills required. Intermediate level of Microsoft Word and PowerPoint.

Required Experience:

One year of applicable experience, if candidate has no experience they must have completed a successful healthcare or finance oriented internship with good references or an extensive managed care or an analytical background. Knowledge of healthcare reimbursement with a familiarity of CPT codes, DRGs, ICD-9s, & billing methodology for hospitals and physician practices. An understanding of managed care contracts and experience in contract variance reporting, denials and appealsis helpful. Demonstrated experience in problem-solving, critical thinking, accomplishing tasks on assigned timelines, and evidence of sound judgement. Excellent PC, Excel skills and ability to learn and use new software applications is important. Excellent communication and customer service skills. Given experience and on-the job training, incumbent should be proficient in the basic aspects of the position in three months of employment date.

Job Type: Full-time

Pay: $45,000.00 - $68,000.00 per year

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday
• No weekends

Work setting:

• Hospital
• In-person

Experience:

• Data analytics: 1 year (Preferred)

Ability to Commute:

• Hickory, NC (Required)

Work Location: In person