Managed Care Coordinator

ID
2023-21218
Location
Cone Health
Work Location
US-NC-Greensboro
Division : Name
System Wide
Department : Name
SW-Pt Acct Rev Integrity
Category
PROFESSIONAL/MNGMNT
Position Sub-Category
PROFESSIONAL/MNGMNT
Position Type
Full Time (40 hours/week)
Employment Type
Employee
Exempt/NonExempt
Exempt
FTE
1.00
Workforce Status
Hybrid I
Work Hours
40.00
Provider Schedule (specific schedule)
M-F, 8-5
On call Required
No
Sub Category
Professional/Management

Overview
This position is responsible for accurately analyzing, implementing and monitoring contractual relationships in support of Managed Care goals and objectives.
Serves as a liaison between, Cone Health, Carolinas Health System and payers to accurately administer Managed Care contract terms, resolve problems, troubleshoot and provide customer service.

Talent Pool: Corporate Services/Professional

Responsibilities
Implement the startup of newly negotiated managed care contracts. Oversee operational relationships with established managed care contractors.
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Serve as an internal resource to operating divisions/departments in the interpretation and implementation of current and revised contract provisions. Manage the flow of information to the appropriate staff and facilitate problem resolution.
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Assist with coding of contract databases, development, performance, and documentation of tasks for the appropriate contract management applications.
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Coordinate electronic access to payer websites for Health System staff.
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Monitors/trends contract/payer performance and outcomes for purposes of compiling summary data for administrative and managerial review.
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Works with denial team and underpayment team to coordinate/administer appeal efforts for reimbursement not made in compliance with contract terms.
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Assist in certain managed care efforts for hospital based staff physicians, psychologists and other professional providers.
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Qualifications
EDUCATION: Associates, Business Administration, Required
Bachelors, Business Administration, Preferred
Associate Degree in Business Administration, Accounting or a related field or equivalent work experience required; Bachelor's Degree preferred.
EXPERIENCE: 3-5, Required
6-7, Preferred
Minimum of 3-5 years in a medical/insurance environment; 6-7 years preferred. Health Information Management with electronic medical records and EPIC experience preferred.
LICENSURE/CERTIFICATION/REGISTRY/LISTING: REQUIRED
N/A
PREFERRED
N/A