Job Details:

Job Summary:

The Managed Care Specialist under the direction of the Senior Director of Managed Care will assist in working with the participating managed care payers on escalated managed care contractual issues on behalf of WMC Health Network for the Hospital's, Physician Groups and Ancillary Providers. The incumbent will also assist with completion of single case agreements and settlements with both participating and nonparticipating managed care payers. Responsibilities · In coordination with the Senior Director of Managed Care, will escalate to the managed care organizations contractual rate and language issues for the WMC Health Network for the Hospital's, Physician's and Ancillary Agreements. · Responsible to maintain current credentialing status for all Hospital's and ancillary facilities within the WMC Health Network. · Negotiates financially equitable single case agreements with out of network managed care organizations. · Assists in completion of settlements with both participating and non- participating managed care payers. · Assists in identifying, prioritizing, and arranging discussions with non-participating payers requesting a participating agreement with the WMC Health Network. · Maintains current grids for contractual rates and key language items for the network. · Communicates with other departments within the WMC Health Network of ongoing and completed contracts with the managed care payers. · Assists with scheduling and maintaining Joint Operation Committee meetings with the managed care payers as requested by senior leadership. · Other job duties as assigned. Qualifications/Requirements:

Experience:

Minimum of four years of progressive experience in a managed care contracting setting. Basic knowledge of reimbursement methodologies, such as MSDRG, APR DRG, CPT-4, HCPCS, UB04 and NYS regulations as they relate to Managed Care Organizations. Minimum of two to four years of progressive experience in managed care contracting. Basic knowledge of reimbursement methodologies, CPT-4, HCPCS, UB04 and NYS regulations as they relate to Managed Care Organizations. Excellent written and verbal communications skills.

Education:

Bachelor's degree in Business, Finance, or a related field required

Licenses / Certifications:

N/A

About Us:

NorthEast Provider Solutions Inc.

Benefits:

We offer a comprehensive compensation and benefits package that includes:

Health Insurance Dental Vision Retirement Savings Plan Flexible Savings Account Paid Time Off Holidays Tuition Reimbursement

 

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