Managed Care Operations Manager
About The Position
Responsible for managed care operations activities for UMass Memorial Medical Center and UMass Memorial Medical Group (collectively “UMMHC”). Acts as primary liaison with managed care plans relative to the research and resolution of claims payment discrepancies. At UMass Memorial Health, everyone is a caregiver – regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 20,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other. And everyone, in their own unique way, plays an important part, every day.
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, is required.
- A thorough understanding of clinical operations, hospital and physician billing and health care terminology, and managed care policy required.
- Excellent verbal and written communication skills.
Nice To Haves
- Former managerial experience is preferred.
Responsibilities
- Responsible for resolution of operational issues impacting claims payment, including billing, patient registration, referral and authorization, credentialing, and provider set up issues.
- Works with internal and external customers to improve workflow and resolve payment discrepancies.
- Researches UMMHC contractual requirements and operational policies to ensure health plan compliance with negotiated financial arrangements.
- Coordinates efforts with management within Contracting and Provider Relations.
- Provides effective direction, guidance, and leadership in conducting monthly claims meetings and fosters effective teamwork in problem resolution.
- Coordinates the assignment of tasks and helps resolve technical and operational problems.
- Evaluates the impact of solutions to ensure goals are achieved.
- Participates in performance improvement initiatives and demonstrates the use of quality improvement in daily operations.
- Ensures compliance with regulatory agencies such as Joint Commission, DPH, etc.
- Develops and maintains procedures necessary to meet regulatory requirements.
- Ensures that duties comply with hospital established policies, quality assurance programs, safety, and infection control policies and procedures.
Benefits
- Signing bonus available
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What This Job Offers
Job Type
Full-time
Career Level
Manager
