Managed Care Coordinator

Description

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Summary:

The Managed Care Coordinator assists in the day- to- day activities of the Payer Policy Analytics function. This position will help coordinate and organize functions related to any Commercial, Medicare Advantage and Managed Medicaid policies that could potentially affect reimbursement across UNC Health, whether Hospital based billing or Physician based billing. Assists with sustaining relationship with members of managed care service providers. Assists with being a resource, answering questions and providing information about Reimbursement Policies that currently, or will in the future, affect UNC Health.

Responsibilities:

1. Managed Care Analysis- Research, coordinate and analyze Payer Reimbursement Policies and associated updates on a regular basis. Provides summarized and necessary information to senior Analytic team members, including Contract Management leadership when required. Analyzes financial, contractual, and operational issues related to contracted payers. Organizes the analysis of payer reimbursement programs, and deciphers the potential revenue impacts to any affected UNC Health location, including Physicians.
2. Consults with internal subject matter experts and others within Managed Care to resolve the roadblocks to understanding and application of Payer Policies. Utilizes internal and external sources of information to improve analysis efforts and identifying essential policy content.
3. Uses Business Objects, Strata and other UNC approved reporting tools like Sharepoint and Tableau, to capture and present relevant data when working through Policy analysis. Reviews billings and claims payments according to managed care contracts as needed.
4. Contract Negotiation- Provide assistance to the process of entering into Single Case Agreements within UNC Health, when necessary. Ensures that SCA terms meet guidelines established by Contract Managers and the UNC Health Legal department.
5. Price Transparency - Knowledge of current CMS requirements pertaining to the annual update of Hospital Price Transparency, including assisting with generation of the Machine Readable File (MRF) as appropriate. Research applicable updates to the requirements handed down by CMS.
6. Other - Attends meetings, participates in group discussion, and works with other adjacent departments, when necessary, i.e. PFS, ISD, HIM.
   
7. Note - this is NOT a patient care or patient facing position in any way.

Other information:
Education Requirements:

• Bachelor's degree in relevant field

• No licensure or certification required.

• If Bachelor's degree, requires two (2) years of experience with managed care contracts and provider relations.
• If Associate's degree, requires six (6) years of experience with managed care contracts and provider relations.
• If High School diploma or GED, requires ten (10) years of experience with managed care contracts and provider relations.
• If Master's degree, requires zero (0) year of experience

Legal Employer: NCHEALTH

Entity: Shared Services

Organization Unit: Managed Care

Work Type: Full Time

Standard Hours Per Week: 40.00

Salary Range:$28.59 - $41.09 per hour (Hiring Range)

Pay offers are determined by experience and internal equity

Work Assignment Type: Remote

Work Schedule: Day Job

Location of Job: US:NC:Morrisville

Exempt From Overtime: Exempt: Yes

This position is employed by NC Health (Rex Healthcare, Inc., d/b/a NC Health), a private, fully-owned subsidiary of UNC Health Care System, in a department that provides shared services to operations across UNC Health Care; except that, if you are currently a UNCHCS State employee already working in a designated shared services department, you may remain a UNCHCS State employee if selected for this job.

Qualified applicants will be considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, status as a protected veteran or political affiliation.

UNC Health makes reasonable accommodations for applicants' and employees' religious practices and beliefs, as well as applicants and employees with disabilities. All interested applicants are invited to apply for career opportunities. Please email applicant.accommodations@unchealth.unc.edu if you need a reasonable accommodation to search and/or to apply for a career opportunity.