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Managed Care Specialist
WMCHealth • Valhalla, NY 10595 • Posted 30+ days ago
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In-person • Full-time • $31.69-$39.83/hr • Mid Level
Job Highlights
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The Managed Care Specialist at NorthEast Provider Solutions Inc. will work under the direction of the Senior Director of Managed Care to handle escalated managed care contractual issues for WMC Health Network. This includes maintaining credentialing status, negotiating single case agreements, settling with payers, and assisting with network participation. The role requires a minimum of four years of managed care contracting experience and a bachelor's degree in a related field.
Responsibilities
- Escalate to managed care organizations contractual rate and language issues for the WMC Health Network.
- Maintain current credentialing status for all Hospital's and ancillary facilities within the WMC Health Network.
- Negotiate financially equitable single case agreements with out of network managed care organizations.
- Assist in completion of settlements with both participating and non-participating managed care payers.
- Identify, prioritize, and arrange discussions with non-participating payers requesting a participating agreement.
- Maintain current grids for contractual rates and key language items for the network.
- Communicate with other departments within the WMC Health Network of ongoing and completed contracts with the managed care payers.
- Assist with scheduling and maintaining Joint Operation Committee meetings with the managed care payers as requested by senior leadership.
Qualifications
Required
- 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.
- Bachelor's degree in Business, Finance, or a related field required.
About WMCHealth
Westchester Medical Center Health Network (WMCHealth) is a prominent healthcare system in the Hudson Valley region with nine hospitals on seven campuses. They provide a wide range of services, including trauma care, burn treatment, children's healthcare, and specialized institutes and centers, as well as mental health services and homecare. WMCHealth is dedicated to transforming healthcare and prioritizing patient well-being through a Culture of Care.
Full Job Description
Managed Care Specialist
Company: NorthEast Provider Solutions Inc.
City/State: Valhalla, NY
Category: Clerical/Administrative Support
Department: Managed Care-WMC Health
Union: No
Position: Full Time
Hours: mon-fri 40 hours
Shift: Day
Req #: 40204
Posted Date: Aug 14, 2024
Hiring Range: $31.69 - $39.83
Apply Now
External Applicant link (https://pm.healthcaresource.com/cs/wmc1/#/preApply/27148) Internal Applicant link
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
Apply Now
External Applicant link (https://pm.healthcaresource.com/cs/wmc1/#/preApply/27148) Internal Applicant link
Talent Community
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Hiring Events (https://wmchealthjobs.org/job-events-list/)
Company: NorthEast Provider Solutions Inc.
City/State: Valhalla, NY
Category: Clerical/Administrative Support
Department: Managed Care-WMC Health
Union: No
Position: Full Time
Hours: mon-fri 40 hours
Shift: Day
Req #: 40204
Posted Date: Aug 14, 2024
Hiring Range: $31.69 - $39.83
Apply Now
External Applicant link (https://pm.healthcaresource.com/cs/wmc1/#/preApply/27148) Internal Applicant link
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
Apply Now
External Applicant link (https://pm.healthcaresource.com/cs/wmc1/#/preApply/27148) Internal Applicant link
Talent Community
Search Jobs
Hiring Events (https://wmchealthjobs.org/job-events-list/)
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