We have other current jobs related to this field that you can find below

  • RN Care Coordinator- Evernorth- Maitland, FL

    4 weeks ago

    Maitland, United States The Cigna Group Full time

    RN - Care Coordinator – Evernorth Direct Health, Maitland FL Evernorth Direct Health is an industry leading business providing custom care delivery and wellness services across four key business lines: Wellness Centers, Health Coaching, Wellness Events and COVID 19 solutions. Evernorth is built on the recognition that health makes progress possible. Our...

  • Care Managers

    3 months ago

    Maitland, United States Compass Senior Solutions Care Manag Full time

    Job DescriptionJob DescriptionThe care manager will ensure all healthcare providers involved are up to date with case information and collaborate with patients' families, friends, and caretakers to effectively share information. The care manager will continually develop a network of quality providers and keep accurate patient records. You will link...

  • Medicaid Application Coordinator

    3 days ago

    Maitland, Florida, United States Compass Senior Solutions Care Manag Full time

    Job OverviewThe Medicaid Application Coordinator plays a crucial role in ensuring the prompt and precise processing of Medicaid Pending applications. This position is essential for gathering and verifying all necessary documentation to facilitate timely submissions to the appropriate County offices. The Coordinator must adhere to established policies and...

  • Patient Registration Coordinator Float Pool

    1 month ago

    Maitland, United States AdventHealth Centra Care Full time

    Patient Registration Coordinator - AdventHealth Centra Care All the benefits and perks you need for you and your family: Commitment to whole-person care, giving you the opportunity to help heal people in mind body and spirit. Fulfilling work with people who treat you like family. Excellent benefits, market-driven wages and career development opportunities....

  • Training Analyst II Primary Care

    1 month ago

    Maitland, United States Primary Care Network Full time

    All the benefits and perks you need for you and your family: Benefits from Day One Paid Days Off from Day One Student Loan Repayment Program Career Development Whole Person Wellbeing Resources Our promise to you: Joining AdventHealth is about being part of something bigger. Its about belonging to a community that believes in the wholeness of each person,...

  • Patient Registration Coordinator Float Pool

    2 months ago

    Maitland, United States AdventHealth Centra Care Full time

    Patient Registration Coordinator - AdventHealth Centra Care All the benefits and perks you need for you and your family: Commitment to whole-person care, giving you the opportunity to help heal people in mind body and spirit. Fulfilling work with people who treat you like family. Excellent benefits, market-driven wages and career development opportunities....

  • Patient Registration Coordinator Float Pool

    3 weeks ago

    Maitland, United States AdventHealth Centra Care Full time

    Patient Registration Coordinator AdventHealth Centra Care Float Pool All the benefits and perks you need for you and your family: Benefits from Day One Paid Days Off from Day One Student Loan Repayment Program Whole Person Wellbeing Resources Mental Health Resources and Support Our promise to you: Joining AdventHealth is about being part of something...

  • Training Analyst II Primary Care

    4 weeks ago

    Maitland, United States Right Hand Senior Care Full time

    All the benefits and perks you need for you and your family: - Benefits from Day One - Paid Days Off from Day One - Student Loan Repayment Program - Career Development - Whole Person Wellbeing Resources - Our promise to you: Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of...

  • Team Manager Home Care

    3 months ago

    Maitland, United States VITAS Healthcare Full time

    The Team Manager is the leader of the Patient Care Team and that member of the team whose function is to: supervise, evaluate and coordinate the various component members of the interdisciplinary team; assure continuity of care from admission to discharge or transfer to bereavement; serve as patient advocate and coordinator for other social service and...

  • Provider Relations Experience Manager

    4 weeks ago

    Maitland, Florida, United States The Cigna Group Full time

    ***Please note incumbent must geographically reside in Kissimmee, FL or Orlando, FLPOSITION SUMMARY:This position is a high functioning role with account management and strategic planning responsibilities for a specific Health Care Professional (HCP) Book of Business. The role is accountable for the overall Health Care Professional Experience by working in...

  • Sales Coordinator

    3 weeks ago

    Maitland, United States Starling Full time

    Position Summary Responsible for generating leads, lead management, sales presentations, closing sales, and meeting monthly sales expectations. The sales coordinator will work in close collaboration with the Sales Director to facilitate the daily operations of the sales office and assist the team in achieving the community’s occupancy and revenue...

  • Sales Coordinator

    2 months ago

    Maitland, United States Starling Full time

    Position Summary Responsible for generating leads, lead management, sales presentations, closing sales, and meeting monthly sales expectations. The sales coordinator will work in close collaboration with the Sales Director to facilitate the daily operations of the sales office and assist the team in achieving the community’s occupancy and revenue goals....

  • Accounting Manager

    7 days ago

    Maitland, United States Complete Care Full time

    Job DescriptionJob DescriptionAbout Us: Complete Care is expanding rapidly and is seeking an experienced Accounting Manager to join our dynamic Accounting Department. We are looking for a professional who is not only detail-oriented and organized but also has a solid background in accounting, including significant experience with audit firms. This role is...

  • Operations Coordinator

    2 months ago

    Maitland, United States The Green Recruitment Company Full time

    Job Summary: The Operations Coordinator will be responsible for overseeing daily operations and ensuring smooth and efficient workflows across various departments. This role requires a highly organized individual who can work independently, manage multiple tasks, and support our operational goals.Key Responsibilities:Monitor and manage operational...

  • Operations Coordinator

    2 months ago

    Maitland, United States The Green Recruitment Company Full time

    Job Summary: The Operations Coordinator will be responsible for overseeing daily operations and ensuring smooth and efficient workflows across various departments. This role requires a highly organized individual who can work independently, manage multiple tasks, and support our operational goals.Key Responsibilities:Monitor and manage operational...

  • Proposal Coordinator

    2 months ago

    Maitland, United States Colliers Engineering & Design Full time

    Overview: Colliers Engineering & Design is seeking a Proposal Coordinator to work in our Orlando, FL office. In this role, you will coordinate and manage the development of proposals and statements of qualifications and support major proposal pursuits. This includes working with Project Managers and the project team to gather appropriate...

  • Sales Coordinator

    2 months ago

    Maitland, Florida, United States Taylor Morrison Full time

    Job Description SummaryAs a Sales Coordinator working for Taylor Morrison, you will provide support to the Sales team and exemplify excellent customer service. Ensure annual sales initiatives aligned with company initiatives are completed. Communicate with management staff to stay updated on jobs, documentation, budgeting, and any customer issues.Job...

  • Patient Account Management Specialist

    4 days ago

    Maitland, Florida, United States Complete Care Full time

    Job OverviewAre you prepared to embrace a multifaceted role that merges leadership skills, administrative capabilities, and outstanding client service abilities? We are in search of a committed and skilled professional to take on the essential role of Billing Account Manager at Complete Care.Role Summary: The Billing Records Chart Auditor plays a crucial...

  • Program Manager

    2 months ago

    Maitland, United States COPILOT Full time

    Job DescriptionJob DescriptionProgram Manager with Hub Experience - NEEDED ASAPExcellent Opportunity at a Growing Company!Bring your program management, coordination, attention to detail, and/or insurance skills to an innovative, team-oriented, healthcare hub services company! Join our friendly and supportive team and make a positive difference! Seeking...

  • Recruiting Coordinator

    2 months ago

    Maitland, United States Tetra Tech Full time

    Are you ready to take the next step in your career? Do you want to do meaningful work that improves quality of life? At Tetra Tech, you will work with high-performing teams who are passionate about using their expertise to find solutions to complex problems in water, environment, infrastructure, resource management, energy, and international development....

Managed Care Coordinator-Onsite Kansas City

2 months ago

Maitland, United States AdventHealth Corporate Full time

AdventHealth - This position is in Kansas City

All the benefits and perks you need for you and your family:

Benefits from Day One

Career Development

Whole Person Wellbeing Resources

Mental Health Resources and Support

Our promise to you:

Joining AdventHealth is about being part of something bigger. Its about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.

Shift : Monday-Friday

Job Location : Onsite - 9119 W 74th St, Merriam, KS 66204

This position is in Kansas City

The role youll contribute:

The Managed Care Coordinator is a responsible member of a multi-disciplinary team. S/he represents AdventHealth to payors, serving to validate that payor contractual obligation in terms of updated fee schedules and modifications to contracts. S/he must manage the contracts, therefore, must have a high degree of understanding of the requirements of each Agreement for all hospital, ancillary, and physician services. In addition, s/he must communicate regularly with clinical and support staff in order to obtain the optimum reimbursement, decrease operational overhead, and maximize patient benefits.

The value youll bring to the team:

Provide documentation to internal departments on managed care contract requirements and changes including but not limited to, policy changes on prior authorization, concurrent review, referral requirements, billing, and collections.

Ensure all payors have accurate and extensive information regarding all AHSM providers. Provide updates as they occur and monthly.

Work closely with payors to understand new insurance products. Ensure that internal departments are prepared to work within the confines of any new benefit plan.

Facilitate open communication and joint decision making with associates, payors, and physicians.

Fosters collaborative relationships with other departments and payors to identify areas in need of improvement.

Build relationships with payors.

Communicates frequently with staff through informal and formal process, e.g. staff meetings and emails.

Maintain all hospital and ancillary entity credentialing files to include licensure, liability insurance and other reference materials required by payors. Ensure all payor required credentialing needs are met on a timely basis.

Maintain current accreditation information for regional facilities.

Manages priorities within the department.

Provide claim analysis to support other departments.

Acts promptly and decisively to address problems that arise in the department.

Assist in any performance improvement initiatives.

Anticipates and recognizes areas of concern that may have a financial impact.

Facilitate payor operational meetings.

Resolves complaints and conflicts in a timely manner. Assist in resolving claim problems in a timely manner.

Develop tools to facilitate organizational learning, e.g. participation list, payment matrices, contract pricing worksheets.

Provide pricing information and payer medical policy information for Proforma requests.

Provide payer rate comparisons.

Negotiate assigned hospital, ancillary and physician contracts.

Perform language analysis to determine acceptable provisions. Ensure financial and operational impact is kept to a minimum.

Monitor payors to ensure compliance with the contract's financial language provisions.

Assists with Single Case Agreements if needed.

Ensures adherence to applicable AdventHealth polices and regulatory standards.

Qualifications

The expertise and experiences youll need to succeed:

KNOWLEDGE AND EXPERIENCE STRONGLY PREFERRED:

General knowledge of healthcare, hospital and provider operations, and managed care payer contracts and operations.

KNOWLEDGE AND EXPERIENCE PREFERRED:

Must have a high degree of understanding of the managed care payers and managed care contracting requirements.

Knowledge of healthcare, hospital/provider operations and managed care payer operations.

EDUCATION AND EXPERIENCE REQUIRED:

  • 3 years experience
  • Three to Five years of Managed Care or position-related experience

EDUCATION AND EXPERIENCE PREFERRED :

Bachelor's Degree from a four-years college or university

Three to Five years of Managed Care or position-related experience

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances. The salary range reflects the anticipated base pay range for this position. Individual compensation is determined based on skills, experience and other relevant factors within this pay range. The minimums and maximums for each position may vary based on geographical location.

Category: Managed Care

Organization: AdventHealth Corporate

Schedule: Full-time

Shift: 1 - Day

Req ID: 24014468

We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.