Managed Care Specialist

Department:

13385 Enterprise Corporate - Managed Health Payor Contracting

Status:

Full time

Benefits Eligible:

Yes

Hours Per Week:

40

Schedule Details/Additional Information:

• First shift with some flexibility (8-5, 7-4, 9-6)

• Fully Remote Role from these states: AL, AK, AR, AZ, DE, FL, GA, IA, ID, IL, IN, LA, KS, KY, ME, MI, MO, MS, MT, NC, ND, NE, NH, NM, NV, OH, OK, PA, SC, SD, TN, TX, UT, VA, WI, WV, WY. Due to complex requirements, remote work is NOT permitted for short or long periods in: CA, CO, CT, HI, MA, MD, MN, NJ, NY, OR, RI, VT, WA and working Internationally (this includes working while on vacation).

• No relocation, No Sponsorship or transfer of visa for this position now or in the future.

Pay Range

$28.55 - $42.85

You will manage the administration of the contract portfolio and the day-to-day relationships between the System and Managed Care Organizations (MCOs) within that portfolio. Coordinates the financial, legal, operation and other administrative processes between the Systems and MCOs that are necessary to secure new contracts and maintain the viability of existing contracts. Supports designated leaders as assigned.

Essential Functions

• Manages administration of the assigned portion of the contract portfolio.

• Maintains current detailed working knowledge of all assigned payor contracts, and manages all activities related to managed care contract administration and compliance including, but not limited to: Chargemaster Increases, Contract Rate Adjustments, Contract Critical Events, Entity and Contract Database, and MHR document distributions.

• Creates and maintains electronic document database as well as original permanent files of all contract documents for all MCO contracts for the System.

• Communicates and educates operational implementation of new contract terms that affect revenue cycle functions.

• Manages the implementation process for all new or renegotiated managed care agreements.

• Manages the secure distribution of confidential contract documents and communicates contract changes to executives, revenue cycle personnel and others within the System.

• Monitors, reports, resolves and prevents operational issues related to existing managed care contracts. Routinely interacts with revenue cycle staff and MCO provider relations to resolve any trended or escalated operational issues that arise during the term of the contract.

• Serves as advisor and point of contact for all revenue cycle personnel for trended managed care operational and administrative issues. Supports the designated teammates and Managed Health Resources (MHR) Provider Services in their operational roles.

• Initiates and facilitates Joint Operating Committee (JOC) meetings with MCOs and facilitates internal meetings with revenue cycle staff for issue resolution and contract performance improvement. Coordinates all JOC and operational meetings, creates and distributes the agenda, creates performance reports and meeting minutes.

• Reviews assigned payor websites and external information, staying current with regard to changes to payor policies and other initiatives.

• Prepares clear, concise and focused internal communication/correspondence.

• Determines where to gather data based on requests; performs analyses and methodology application, under supervision, noting sources and methods.

Education, Experience and Certifications:

• Associate's degree or equivalent experience required.

• Minimum two years' experience in managed care contracting, operations, or patient financial services for large healthcare provider or managed care organization

• Proficiency with MS Office

• Strong verbal and written communication skills

Preferred experience:

• Managed care or insurance experience

Physical Requirements

• Performs most work under normal office conditions; may include sitting for long periods of time, standing, walking, using repetitive wrist/arm motion or lifting articles up to twenty-five pounds.

#LinkedIn-Remote

Our Commitment to You:

Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including:

Compensation

• Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
• Premium pay such as shift, on call, and more based on a teammate's job
• Incentive pay for select positions
• Opportunity for annual increases based on performance

Benefits and more

• Paid Time Off programs
• Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
• Flexible Spending Accounts for eligible health care and dependent care expenses
• Family benefits such as adoption assistance and paid parental leave
• Defined contribution retirement plans with employer match and other financial wellness programs
• Educational Assistance Program

About Advocate Health

Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.

Managed Care Specialist AHF