Managed Care Contracting Specialist

Hackensack Meridian Health•Edison, NJ

About The Position

Our team members are the heart of what makes us better. At Hackensack Meridian Health we help our patients live better, healthier lives — and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are just the beginning. It’s also about how we support one another and how we show up for our community. Together, we keep getting better - advancing our mission to transform healthcare and serve as a leader of positive change. The Managed Care Contracting Specialist will be ensuring that proper systems are in place to make sure that internal systems are updated. Coordinates proper loading of rates and fee schedules for the enterprise. Reviews internal calculated reimbursement and incoming payments are in alignment with contractual and payer policies. Works on directed projects tracking managed care contractual payer performance.

Requirements

Bachelor's degree or equivalent experience with a High School diploma, general equivalency diploma (GED), and/or GED equivalent programs.
Minimum of 2 or more years of relevant experience.
Knowledge of Managed Care contracts, Medicare and Medicaid.
Through knowledge of billing requirements and regulations of major payers.
Excellent written and verbal communication skills.
Proficient computer skills that include but are not limited to Google Suite and/or Microsoft Office platforms.

Nice To Haves

Strong analytical skills.
Reporting experience.
Epic billing systems.
Hospital and/or Professional billing experience.

Responsibilities

Ensures contracted rates are disseminated to appropriate internal users and updates internal systems.
Works with Revenue Cycle Operations (RCO) and Digital Technical Services (DTS) systems analysts to ensure correct implementation of Managed Care (MC) contracts for appropriate reimbursement.
Educate RCO leadership regarding contractual interpretation inquiries, contractual structural changes.
Analyzes payer reimbursement to ensure proper claim adjudication, work with MC payer account managers regarding identified contractual payment errors to recover revenue in a timely manner.
Monitor, document and report internal and external trends that contribute to delays in correct payer reimbursement or denial reasons.
Auditing closed balance accounts to ensure accuracy of payments to identify any potential recovery opportunities.
Prepare monthly reports that include but not limited to denials, claim dispute referrals, managed care payer recoveries.
Analyze claims data to perform to identify any internal pricing issues and collaborate with RCO, Contract Operations and DTS for pricing optimization.
Identify contractual areas of concern impacting revenue by closely monitoring financial performance and compliance with MC contract terms to ensure revenue maximization and contractual optimization during the renewal process.
Work closely with MC leadership in developing processes and workflows on trends to increase revenue.
Work with MC Payer account managers to obtain updated rate schedules and fee schedules to update the systems timely.
Perform additional ad hoc projects as assigned.
Other duties and/or projects as assigned.
Adheres to HMH Organizational competencies and standards of behavior.