Managed Care Specialist Full Time

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Summary

The Managed Care Specialist optimizes managed care reimbursement by providing analysis and support during contracting process. Supplies reimbursement reports and analyses. Ensures optimization of net revenue under existing managed care contracts and acts as consultant on managed care issues

Responsibilities

• Single Case Agreements- Manages process for obtaining physician Single Case Agreements (SCAs) with non-contracted payers, for physicians associated with UNC Health Care System. Negotiates agreements within established policies, facilitates execution, and monitors accounts to ensure processing occurs within negotiated terms.
• Payments- Provides reconciliation, direction and training regarding payments. Audit and review, particularly large and complex cases, to ensure that they are adjudicated per the terms of the appropriate payer agreement. Often requires direction and training for staff currently handling these cases.
• Managed Care Analysis- Uses data systems to provide frequent and varied ad hoc reporting to Contract Manager and others, and assists in analyzing data for various contractual relationships. Reviews, resolves and evaluates low pay situations. Identifies trends and pursues resolution.
• Managed Care Audits- Takes independent role in auditing the reimbursement for services provided annually. Works very closely with payers to resolve discrepancies and delinquencies.

Other Information

Other information:

Education Requirements

• Bachelor’s degree in relevant field

Licensure/Certification Requirements

• No licensure or certification required.

Professional Experience Requirements

• If a Bachelor’s degree, requires no additional years of experience If Associate’s degree, requires four (4) years of experience with managed care contracts, data analysis or provider relations. If High School diploma or GED, requires eight (8) years of experience with managed care contracts, data analysis or provider relations.

Knowledge/Skills/and Abilities Requirements

Job Details

Legal Employer: NCHEALTH

Entity: Shared Services

Organization Unit: Managed Care

Work Type: Full Time

Standard Hours Per Week: 40.00

Salary Range: $23.24 – $33.41 per hour (Hiring Range)

Pay offers are determined by experience and internal equity

Work Assignment Type: Remote

Work Schedule: Day Job

Location of Job: US:NC:Morrisville

Exempt From Overtime: Exempt: Yes

This position is employed by NC Health (Rex Healthcare, Inc., d/b/a NC Health), a private, fully-owned subsidiary of UNC Health Care System, in a department that provides shared services to operations across UNC Health Care; except that, if you are currently a UNCHCS State employee already working in a designated shared services department, you may remain a UNCHCS State employee if selected for this job.

Qualified applicants will be considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, status as a protected veteran or political affiliation.

UNC Health makes reasonable accommodations for applicants’ and employees’ religious practices and beliefs, as well as applicants and employees with disabilities. All interested applicants are invited to apply for career opportunities. Please email applicant.accommodations@unchealth.unc.edu if you need a reasonable accommodation to search and/or to apply for a career opportunity.