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Sr Managed Care Assoc WHC/PHO

4 months ago

Baltimore, Maryland, United States MEDSTAR HEALTH Full time

General Summary of Position
Serves as a link between the Washington Hospital Center (WHC-PHO), the MedStar-Managed Care Division, and the managed care companies in order to develop and maintain beneficial managed care relationships between the WHC-PHO members (employed and community-based physicians) and the health plans, assuring that membership is able to work successfully within this managed care environment. Maintains and coordinates member activities, resources and communication modalities including the managed care handbook, updates, and educational programs.

Primary Duties and Responsibilities

Contributes to the achievement of established department goals and objectives and adheres to department policies, procedures, quality standards, and safety standards. Complies with governmental and accreditation regulations.Administrative coordination/management of Managed Care educational programs including Managed Care Forums, Health Plan In-Services, and other educational efforts. Responsibilities include scheduling and coordinating in-services with health plan representatives to ensure presentation content and materials meet MedStar Managed Care guidelines.Researches, drafts and co-presents Managed Care updates for monthly IDX User Group Meetings and periodic Managed Care Forum Webinars.Instructor and administrative manager for internal Managed Care Basics educational program, serving as Managed Care liaison with MedStar Professional Billing Services (MPBS) Training Department and trainees. Maintains schedules, registration test scores and reports. Manages all training resources and materials, contributes to, and implements ongoing program enhancements.Website Administrator of the Managed Care Handbook, managing web design, deployment, development, and maintenance activities, maintaining monthly web-site usage reports, and providing technical support to associates.Completes special analytical and other projects for WHC-PHO Executive Leadership and coordinates with WHC-PHO Network Manager as needed on joint projects related to managed care efforts.Promptly develops, coordinates internal review and distributes urgent managed care and practice informational updates (Managed Care Alerts) as necessary.Develops and maintains in Managed Care Handbook, extensive managed care resources, including plan participation matrices, health plan profiles, provider manuals, product descriptions, sample ID cards, and other plan requirements/policies/procedures, based upon updates derived from various health plan sources; Maintains information on, and acts as resource to staff on access to health plan secured web sites.Assists with internal hospital and professional insurance code requests.Develops and maintains positive working relationships with MedStar external partners to maintain an ongoing mutually beneficial liaison relationship for sharing of important administrative information. Participates in various meetings and on committees including, but not limited to, health plan operations meetings, internal billing and practice operations meetings.Organizes, develops and performs surveys, research projects and other projects as needed, or requested by senior Managed Care staff to update or clarify health plan operational requirements, programs, benefits/coverage, and/or reimbursement in support of Managed Care or provider activities.Works with WHC-PHO and other Managed Care leaders on ad hoc efforts related to managed care participation that may contribute to building and maintaining positive relationships between the WHC-PHO and its membership, including in-services, annual meetings and other activities.Maintains WHC PHO membership information and distribution lists. Monitors WHC-PHO membership status and notifies MedStar Health Plans of changes in WHC-PHO membership status and demographic information.Maintains WHC-PHO website.Participates in meetings and on committees and represents the department and hospital in community outreach efforts.Participates in multi-disciplinary quality and service improvement teams.Performs other duties as assigned.

Minimum Qualifications
Education

  • Bachelor's degree in healthcare field required

Experience

  • Less than 1 year 2 years progressive experience in a managed care setting required and
  • Provider and payer experience and direct experience in working with the health plan payers to identify and implement administrative and operational managed care requirements in the physician provider setting preferred and

Licenses and Certifications

  • No special certification, registration or licensure required

Knowledge, Skills, and Abilities

  • Ability to understand, interpret, document, and conduct training sessions on managed care methods, guides, policies and procedures.
  • Ability to work independently on ongoing projects and assignments, and as part of a team.
  • Effective time management skills.
  • Ability to meet frequent deliverable schedule for work products while maintaining the flexibility to handle daily issues/priorities that arise.
  • Excellent verbal and written communication skills.
  • Proficiency in Excel required.
  • Web-site administration skills/aptitude required.

Why MedStar Health?
At MedStar Health, we understand that our ability to treat others well begins with how we treat each other. We work hard to foster an inclusive and positive environment where our associates feel valued, connected, and empowered. We live up to this promise through:

  • Strong emphasis on teamwork - our associates feel connected to each other and our mission as an organization. In return, our effective team environment generates positive patient outcomes and high associate satisfaction ratings that exceed the national benchmark.
  • Strategic focus on equity, inclusion, & diversity - we are committed to equity for all people and communities. We continue to build a diverse and inclusive workplace where people feel a sense of belonging and the ability to contribute to equitable care delivery and improved community health outcomes at all levels of the organization.
  • Comprehensive total rewards package - including competitive pay, generous paid time off, great health and wellness benefits, retirement savings, education assistance, and so much more.
  • More career opportunities closer to home - as the largest healthcare provider in the Baltimore-Washington, D.C. region, there are countless opportunities to grow your career and fulfill your aspirations.

About MedStar Health
MedStar Health is dedicated to providing the highest quality care for people in Maryland and the Washington, D.C., region, while advancing the practice of medicine through education, innovation, and research. Our team of 32,000 includes physicians, nurses, residents, fellows, and many other clinical and non-clinical associates working in a variety of settings across our health system, including 10 hospitals and more than 300 community-based locations, the largest home health provider in the region, and highly respected institutes dedicated to research and innovation. As the medical education and clinical partner of Georgetown University for more than 20 years, MedStar Health is dedicated not only to teaching the next generation of doctors, but also to the continuing education, professional development, and personal fulfillment of our whole team. Together, we use the best of our minds and the best of our hearts to serve our patients, those who care for them, and our communities. It's how we treat people.

MedStar Health is an Equal Opportunity (EO) Employer and assures equal opportunity for all applicants and employees. We hire people to work in different locations, and we comply with the federal, state and local laws governing each of those locations. MedStar Health makes all decisions regarding employment, including for example, hiring, transfer, promotion, compensation, benefit eligibility, discipline, and discharge without regard to any protected status, including race, color, creed, religion, national origin, citizenship status, sex, age, disability, veteran status, marital status, sexual orientation, gender identity or expression, political affiliations, or any other characteristic protected by federal, state or local EO laws. If you receive an offer of employment, it is MedStar Health's policy to hire its employees on an at-will basis, which means you or MedStar Health may terminate this relationship at any time, for any reason.