Managed Care Coordinator coordinates utilization reviews of managed care contracts using established guidelines and processes. Ensures all clinical operations comply with Medicare and Medicaid guidelines and other managed care policies. Being a Managed Care Coordinator communicates with physicians, discharge planners and others to process referrals, authorization for services, and capture data related to utilization. Maintains managed care contracts and information databases and prepares reports. Additionally, Managed Care Coordinator typically requires an associate degree in nursing. Typically reports to a supervisor or manager. Typically requires Registered Nurse (RN). The Managed Care Coordinator has gained full proficiency in a broad range of activities related to the job. Independently performs a wide range of complex duties under general guidance from supervisors. To be a Managed Care Coordinator typically requires 5-7 years of related experience. (Copyright 2024 Salary.com)
Cabell Huntington Hospital is seeking a full-time Managed Care Financial Analyst to work alongside our Contract Management Department.
The Managed Care Financial Analyst is responsible for ensuring accuracy of third party insurance payments according to contractual and state/federal reimbursement guidelines and policy. Identifies underpayments and works with patient accounting department and third party payor to resolve/appeal. Assist in payor relations and provider contracting. Maintains contract management pricing software. Negotiates single case agreements. Assist in preparation, maintenance, and compliance of pricing transparency requirements and disclosures. Assist in various other financial analysis.
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