Managed Care Provider Relations Manager jobs in the United States

Job Details:

Job Summary:

The Manager of Managed Care will report directly to the Vice President of Managed Care and will be responsible to lead the Managed Care Specialist and Ancillary Contractor in single case agreements (SCA’s), credentialing, and assisting with managed care contracts, including Pay for Performance and Centers of Excellence.

Responsibilities:

• Oversees the Single Case Agreements (SCA’s) process on behalf of the Network, including updates on the various SCA trackers and provide recommendations to the process.
• Responsible to ensure all hospital and ancillary credentialing are completed timely for the Network.
• Oversees all Hospital settlements to ensure payment for additional revenue for the Network.
• Assists VP Managed Care with managed care in negotiations on behalf of the Network. This includes existing payers and first time payers.
• Responsible for review of managed care contracts, including redlining of contract language and rate sheets for the Network.
• Works closely with Patient Accounts, Revenue Cycle, Utilization Management and Medical Records to ensure the managed care payers are adhering to the terms of the agreement and rates.
• Responsible for Joint Operation Committee meetings with the managed care payers.
• Responsible for maintaining and providing the network with current payer rate grids including Hospital, Professional, Home Care and key language grids for the Network.
• Ability to efficiently and proactively manage others, with a strong ability to communicate well both verbally and in writing.
• Demonstrates strong project management skills.
• Ability to multi-task on a daily basis.
• Ability to assist with various reports.
• Other job duties as assigned.

Experience:

• Five to seven years of managed care experience in an academic medical center.
• Five years management experience.

Education:

Bachelor’s degree in Finance, Business Administration, Hospital Administration, or a closely related field, required. Master’s degree, preferred. Licenses / Certifications. N/A

Other:

Special Requirements:

• Thorough knowledge of various reimbursement methodologies, such as MSDRG, APR DRG, CPT-4, HCPCS, UB04 and NYS, CMS regulations as they relate to Managed Care Organizations.
• Strong experience in managed care contracting.
• Demonstrated proficiency in Microsoft Excel. Preferred experience with Access, Cerner Millennium or other EMR/Billing systems.
• Displays critical thinking to proactively diagnose root cause of issues and develop solutions.
• Has the ability to independently obtain, vet, analyze, and accurately summarize managed care agreements and data using all tools available.
• Clearly and accurately, communicate data, report results, and other findings both in writing and verbally.

About Us:

NorthEast Provider Solutions Inc.

Benefits:

• Health Insurance
• Dental
• Vision
• Retirement Savings Plan
• Flexible Saving Account
• Paid Time Off
• Holidays
• Tuition Reimbursement