Job Details

Overview

To serve as primary point of contact with assigned managed care companies on all negotiating and operational issues. Responsible for monitoring contracts, financial performance as well as payor compliance with all terms and conditions. Upholds positive relations with payors and internal customers, including revenue cycle, legal, clinic/hospital operations, and providers. Facilitates problem resolution, communication flow, and education while also maintaining appropriate documentation of issues and activities.

Qualifications

Minimum Education and Experience Requirements:

Bachelor's degree in business or a health care related field required. Advanced managed care experience may substitute for the degree on a year-by-year basis. Requires two years in managed care industry experience in at least two of the following areas: contract language review, financial negotiation of hospital and physician contracts, provider relations, revenue cycle, financial or reimbursement analysis, NCQA/HEDIS requirements, AHCA/CMS regulations, utilization review/management, member services, or account/service management (marketing). Master's degree may substitute for the required experience on a year-by-year basis. Prefer three to five years of managed care experience.

Motor Vehicle Operator Designation:

None provided. Licensure/Certification/Registration: None