Location | Cone Health | Work Location | US-NC-Greensboro | Division : Name | Finance | Department : Name | SW-Pt Acct Rev Integrity | Category | PROFESSIONAL/MNGMNT | Position Sub-Category | PROFESSIONAL/MNGMNT | Position Type | Full Time (40 hours/week) | Employment Type | Employee | Exempt/NonExempt | Exempt | FTE | 1.00 | Workforce Status | Hybrid I | Work Hours | 40.00 | Provider Schedule (specific schedule) | M-F, 8-5 | On call Required | No | Sub Category | Professional/Management |
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 |