Managed Care Operations Director

4 weeks ago


Worcester, Massachusetts, United States U Mass Memorial Health Full time
Job Summary

As a key member of the UMass Memorial Health team, the Managed Care Operations Manager will be responsible for resolving operational issues impacting claims payment, including billing, patient registration, referral and authorization, credentialing, and provider set up issues. This role requires strong communication and leadership skills to work with internal and external customers to improve workflow and resolve payment discrepancies.

Key Responsibilities

* Research UMMHC contractual requirements and operational policies to ensure health plan compliance with negotiated financial arrangements.
* Coordinate efforts with management within Contracting and Provider Relations to ensure seamless operations.
* Provide effective direction, guidance, and leadership in conducting monthly claims meetings and foster effective teamwork in problem resolution.
* Coordinate the assignment of tasks and help resolve technical and operational problems, evaluating the impact of solutions to ensure goals are achieved.

Requirements

* Bachelor's degree or equivalent in Business Administration, Health Care Management, or related discipline.
* Minimum of 5-7 years of experience in a managed care setting, with a thorough understanding of managed care plan operations, clinical operations, hospital and physician billing, and health care terminology.
* Excellent verbal and written communication skills, with former managerial experience preferred.

Why Join Us

At UMass Memorial Health, we strive to make respect a part of everything we do. Our six Standards of Respect are: Acknowledge, Listen, Communicate, Be Responsive, Be a Team Player, and Be Kind. If you share these Standards of Respect, we encourage you to apply and join our team in making respect our standard for everyone, every day.
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