Address
Form of work
SalaryAdventHealth -This position is based North Carolina
All the benefits and perks you need for you and your family:
- Benefits from Day One
- Career Development
- Whole Person Wellbeing Resources
- Mental Health Resources and Support
Our promise to you:
Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.
Shift : Monday-Friday
Job Location : 100 Hospital Drive, Hendersonville, NC 28792
The role you’ll contribute:
The Managed Care Coordinator is a responsible member of a multi-disciplinary team. S/he represents AdventHealth to payors, serving to validate that payor contractual obligation in terms of updated fee schedules and modifications to contracts. S/he must manage the contracts, therefore, must have a high degree of understanding of the requirements of each Agreement for all hospital, ancillary, and physician services. In addition, s/he must communicate regularly with clinical and support staff in order to obtain the optimum reimbursement, decrease operational overhead, and maximize patient benefits.
The value you’ll bring to the team:
- Provide documentation to internal departments on Managed Care contract requirements and changes including but not limited to, policy changes on prior authorization, concurrent review, referral requirements, billing, and collections.
- Ensure all payors have accurate and extensive information regarding all AHSM providers. Provide updates as they occur and monthly.
- Work closely with payors to understand new insurance products. Ensure that internal departments are prepared to work within the confines of any new benefit plan.
- Facilitate open communication and joint decision making with associates, payors, and physicians.
- Fosters collaborative relationships with other departments and payors to identify areas in need of improvement.
- Build relationships with payors.
- Communicates frequently with staff through informal and formal process, e.g. staff meetings and emails.
- Maintain all hospital and ancillary entity credentialing files to include licensure, liability insurance and other reference materials required by payors. Ensure all payor required credentialing needs are met on a timely basis.
- Maintain current accreditation information for regional facilities.
- Manages priorities within the department.
- Provide claim analysis to support other departments.
- Acts promptly and decisively to address problems that arise in the department.
- Assist in any performance improvement initiatives.
- Anticipates and recognizes areas of concern that may have a financial impact.
- Facilitate payor operational meetings.
- Resolves complaints and conflicts in a timely manner. Assist in resolving claim problems in a timely manner.
- Develop tools to facilitate organizational learning, e.g. participation list, payment matrices, contract pricing worksheets.
- Provide pricing information and payer medical policy information for Proforma requests.
- Provide payer rate comparisons.
- Negotiate assigned hospital, ancillary and physician contracts.
- Perform language analysis to determine acceptable provisions. Ensure financial and operational impact is kept to a minimum.
- Monitor payors to ensure compliance with the contract's financial language provisions.
- Assists with Single Case Agreements if needed.
- Ensures adherence to applicable AdventHealth polices and regulatory standards.
Qualifications
The expertise and experiences you’ll need to succeed:
KNOWLEDGE AND EXPERIENCE STRONGLY PREFERRED:
- General knowledge of healthcare, hospital and provider operations, and Managed Care payer contracts and operations.
KNOWLEDGE AND EXPERIENCE PREFERRED:
- Must have a high degree of understanding of the Managed Care payers and Managed Care contracting requirements.
- Knowledge of healthcare, hospital/provider operations and Managed Care payer operations.
EDUCATION AND EXPERIENCE REQUIRED:
- Bachelors and 3 years experience
EDUCATION AND EXPERIENCE REQUIRED :
- Bachelor's Degree from a four-years college or university
- Three to Five years of Managed Care or position-related experience
EDUCATION AND EXPERIENCE PREFERRED :
- Master's degree preferred, or commensurate work experience
- Minimum of five years of position-related experience
This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances. The salary range reflects the anticipated base pay range for this position. Individual compensation is determined based on skills, experience and other relevant factors within this pay range. The minimums and maximums for each position may vary based on geographical location.
Category:Managed Care
Organization: AdventHealth Corporate
Schedule: Full-time
Shift: 1 - Day
Req ID: 24009069
We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.
