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Managed Care Coordinator
3 months ago
Baptist Health is the largest healthcare system serving central Alabama, providing comprehensive hospital-based and outpatient services to nearly 60 percent of the residents in Montgomery, Autauga and Elmore counties.
Managed Care Coordinator will be responsible for overseeing the planning, implementing, monitoring and effectively utilizing contracted agreements with managed care payors, other contracted payors, individual letters of agreement, contracts with at risk medical groups, and alternative payment model contracts for Baptist Health as well as making recommendations to improve the efficiency of our current processes surrounding contract development and implementation.
The coordinator will stay abreast of and disseminate pertinent regulatory and insurance related information in order to promote timely and efficient billing of all inpatient, outpatient, ancillary services, and physician billing as well as building and maintaining relationships with key third party resources to maximize the negotiated results and optimize payor revenue growth.
Additionally, the coordinator will assist, support, and work directly with Revenue Cycle leadership, BH leadership, facility leadership, Central Business Office staff and Physician Billing Office staff to resolve payment and claims processing issues that result from the contracted payors.
The coordinator will collaborate with leadership in planning and implementing coordinated system-wide strategies and goals, coordinating special projects and analyzing the contract analysis and activities.
A strong background in communication is required as the coordinator will provide proactive and responsive communication to payors, BH leadership, internal and external partners plus conducting meetings to review contracted performance and identify opportunities for improvement.
Analyzing and reviewing monthly results for risk against annual plan and forecasted projections and provide variance explanations/recommendations is a key function of this role.
- Bachelor's degree in a related field or 10 years of hospital industry knowledge, hospital billing knowledge and managed care insurance claims processing experience.
- Excellent organizational and communication (written and verbal) skills; required.
- Demonstrated negotiation aptitude and analytical skills; required.
- Working knowledge of computer hardware/software (Microsoft Office Suite); required.
- Excellent interpersonal skills; required.
- Knowledge of Net Revenue and the calculation based on contracted rates for inpatient, outpatient, and Ambulatory claims.
- Expert knowledge of current reimbursement and reporting rules and regulations
- Thorough knowledge of hospital billing, collecting, and reimbursement industry standards
- Thorough knowledge of physician billing, collecting, and reimbursement industry standards
- Knowledge of the regulations related to Medicare and Medicaid, patient rights, compliance, and other related areas
- Knowledge of professional business and communication practices including spoken and written communication
- Ability to articulate thoughts and concepts in a professional manner
- Ability to successfully complete work within time constraints with the ability to multi-task
- Ability to review key performance indicators, identify opportunities, and implement improvement plans
- Ability to create a collaborative environment and promote relationship based care ideas
- Analytical and problem solving ability and attention to detail are important
- Must be able to perform basic mathematical calculations, balance and reconcile figures, punctuate properly, spell correctly and transcribe accurately
