Managed Care Manager

Hospital for Special Surgery•New York, NY

1d•$112,000 - $170,875•Onsite

About The Position

Reporting to the Director of Payer Relations, the Managed Care Manager will play a critical support role in facilitating engagement between Insurance Payers, Revenue Cycle, internal and external billing departments, and various other stakeholders. This position will have particular focus in triaging systemic claims issues to assess the full scope and impact while identifying root cause allowing for successful escalation and resolution. The Managed Care Manager will rely on interpretation of both Payer contracts and polices, along with an understanding of Accounts Receivable, to ensure that issues presented by Revenue Cycle are addressed and resolved in a timely manner.

Requirements

Experience (minimum 3+ years) with Payer or provider contracting and/or Revenue Cycle management.
Possesses knowledge of Payer policies and resolution processes.
Knowledge of the healthcare industry and Payer reimbursement methodologies (both hospital and physician).
Ability to work independently and collaboratively to solve complex problems.
Excellent verbal and written communication skills.
Excellent organizational and multi-tasking skills.

Nice To Haves

Experience with EPIC or other comparable EMR systems preferred.

Responsibilities

Maintain knowledge of Managed Care contracts and Payers’ payment rules and policies.
Work closely with other members of the Managed Care team, Revenue Cycle, and/or professional billing entities to size and resolve identified Payer issues impacting Accounts Receivable and contract performance for both PHO providers and facilities.
Responsible for ensuring reports and updates (i.e., A/R denials, project status, etc.) are disseminated to departmental staff.
Escalate issues as necessary to Payer contacts for resolution with engagement and input from the Managed Care contracting team as needed. Recommend escalation as appropriate to senior management.
Additional responsibilities as required to accomplish departmental goals.