| 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
| Implement the startup of newly negotiated managed care contracts. Oversee operational relationships with established managed care contractors. -------------------------------------------------- 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. -------------------------------------------------- Assist with coding of contract databases, development, performance, and documentation of tasks for the appropriate contract management applications. -------------------------------------------------- Coordinate electronic access to payer websites for Health System staff. -------------------------------------------------- Monitors/trends contract/payer performance and outcomes for purposes of compiling summary data for administrative and managerial review. -------------------------------------------------- Works with denial team and underpayment team to coordinate/administer appeal efforts for reimbursement not made in compliance with contract terms. -------------------------------------------------- Assist in certain managed care efforts for hospital based staff physicians, psychologists and other professional providers. -------------------------------------------------- |
| 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 |
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