Managed Care Coordinator

5 days ago

Dallas, Texas, United States Southwestern Health Resources Full time

Managed Care Coordinator - Contract Support - Southwestern Health Resources 

Southwestern Health Resources is looking for a highly skilled Managed Care Coordinator.  Is that you?

Work Location: Southwestern Health Resources Headquarters, Hybrid: 1601 Lyndon B. Johnson Freeway, Farmers Branch, TX 75234.

Work Hours: Full Time Days (8:00am-5:00pm) for 40 hrs/week (remote work allowed at manager's discretion)

 Department Highlights:

  • Hybrid Position
  • Gain a sense of accomplishment by contributing to a teamwork environment.
  • Receive excellent mentorship, comprehensive training, and dedicated leadership resources.
  • Contribute and work on a cross functional team

What You Will Do: 

Contract management:
Assist CBOs with contractual language to ensure that managed care payments received are in accordance with the terms of the contract.
Responsible for contract administration and implementation:
?�� Coordinate communication with the final contract terms to internal stakeholders (i.e. Central Business Office, Patient Access, Medical Management, Contract Management, Facilities).
?�� Coordinate contract implementation with the CBOs to ensure the contracts are loaded per the intent and work with Payors on contract interpretation issues.
?�� Coordinate communication with other departments/entities on managed care activity and new contracts through the system.
25%
Compliance:
Responsible for monitoring compliance with all aspects of managed care contracts.
Assist in educating SWHR internal stakeholders on managed care rules and regulations as well as individual payor contractual requirements.
20%
Database Administration:
Assist in developing and maintaining a comprehensive database of contractual terms and rates for all SWHR affiliated facilities, inventory and archiving contracts.
Assist in the on-going support and maintenance of SWHR managed care contract database.
20%
Develop and maintain credible relationships with Payors and serve as the interface with Payors for operational and contract compliance issues. 20%
Administrative:
Coordinate, manage, and facilitate Operations and Joint Operating Committee meetings, as needed, between Managed Care, CBOs, Payors, Admissions/Precert, etc. Distribute agendas, minutes, Payor A/R reports, and handouts prior to the meeting.
Responsible for reporting and analysis of variances of managed care information on a monthly or ad-hoc basis.
15%

What You Need: 

Education
Bachelor's Degree Business, Healthcare, or related field Req

Experience
4 Years Experience in managed care, provider relations, payer relations, health care or related field Req


EducationBachelor's Degree Business, Healthcare, or related field ReqExperience4 Years Experience in managed care, provider relations, payer relations, health care or related field ReqSkills Excellent organizational skills, verbal and written communication skills required.
Basic computer skills and proficient knowledge in Microsoft Word, Excel and Powerpoint required
Mode of transportation to payor offices, facilities and outside meetings required.
A keen understanding of managed care contract provisions and hospital reimbursement.SupervisionIndividual ContributorADA RequirementsExtreme Heat 1-33%
Extreme Cold 1-33%
Extreme Swings in Temperature 1-33%
Extreme Noise 1-33%
Working Outdoors 1-33%
Working Indoors 1-33%
Mechanical Hazards 1-33%
Electrical Hazards 1-33%
Explosive Hazards 1-33%
Fume/Odor Hazards 1-33%
Dust/Mites Hazards 1-33%
Chemical Hazards 1-33%
Toxic Waste Hazards 1-33%
Radiation Hazards 1-33%
Wet Hazards 1-33%
Heights 1-33%
Other Conditions 1-33%

Physical Demands
Sedentary

Additional Information

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