Provider Insurance Liaison
2 months ago
**Job Description**:
Be a part of a world-class academic healthcare system at **UChicago Medicine** as a** Provider Relations Advocate** **for the** Managed Care **department.This position is a hybrid remote opportunity with occasional requirements to come in off at our **Hyde Park, IL or Burr Ridge, IL **locations.
**Job Summary**
Responsible for developing and maintaining relationships with UCM hospitals and physicians to support all aspects of the UCM managed care contractual relationships including provider services, provider contract education and communication, provider reimbursement, payer relations and contract compliance. Manage operational and administrative relationships with third party payers and assists in coordinating and facilitating joint operating committee and payer operations meetings to resolve issues. Ensure the delivery of provider services including payer contract updates, payer policy changes, reporting and process improvement for managed care operations. Partner with OMC team members to ensure successful contract implementation, monitoring and enforcement of contract terms and support for value base care contracting initiatives. Support ongoing education to providers and their revenue cycle staff regarding third party payer contract terms, value based care arrangements and insurance market changes.
**Essential Functions and Responsibilities**- Build and maintain provider and third party payer relationships that deliver operational support and efficiencies, ensure compliant administration of contracts, and education and training that results in overall provider and payer satisfaction.
- Maintain regularly scheduled meetings and develop and present educational materials for UCM hospitals and physicians regarding third party payer contract terms, value based care requirements and performance, operational processes and payer/insurance policy and market changes.
- Serve as primary liaison between UCM hospitals and physicians and third party Commercial, Value Based, Medicare Advantage, and Managed Medicaid payers to provide support in resolution of operational and payer compliance issues.
- Manage and facilitate monthly payer joint operating committee meetings and payer operational meetings including scheduling, agendas, meeting minutes and follow-up on action items from the meetings in collaboration with hospital and physician revenue cycle staff with the goal to identify and escalate high level issues for remediation and root cause analysis, as well as, stay informed of payer updates.
- Support Director of Provider and Payer Relations in facilitation of key OMC meetings including Technical Workgroup and OMC Revenue Cycle/UCPG Revenue Cycle, as well as, participates and coordinates periodic meetings with internal UCM key internal stakeholders to share critical information regarding managed care contract updates and market trends.
- Collaborating with the Technical Workgroup, provide the Contracting team with feedback on issues to be addressed in contract negotiations; include policy, operational and claims concerns and data/analysis to strengthen our negotiating position.
**Required Qualifications**
- Bachelor’s Degree required
- Five (5) years managed care health care experience required to include provider relations and claims or network management experience in provider or third party payer setting
- Experience in a multi-facility health system, large academic medical center, or insurer environment highly desirable.
- Direct experience working between providers and third party payers to facilitate issue resolution.
- Strong knowledge base of hospital and physician revenue cycle operations required
- Experience and knowledge of value based care initiatives including risk contracts and population health management highly desirable.
- Specific thorough understanding of physician and hospital coding, claim forms and payer EOBs
- Ability to maintain strong connections to internal providers and external payers through relationship management and exceptional customer service mentality
- Self -starter and ability to take initiative and ownership of work
- Strong written and verbal communication skills
- Strong presentation skills
- Adapts well to rapid change and multiple, demanding priorities with excellent time and project management skills.
- Strong attention to detail and well organized
- Ability to multitask, problem solve, facilitate and collaborate on various work streams and projects. Ability to facilitate discussion and resolution
- Ability to work across a broad network of operational teams and provider locations
- Advanced working knowledge of Microsoft Office Suite, particularly Word, MS Excel and PowerPoint
**Preferred Qualifications**
- Prior experience working for a clinically integrated network - knows how to navigate a complex healthcare environment between physician offices and hospital (academic and community hospitals)- Ability to maintain strong connections to int
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