Managed Care Supervisor supervises and coordinates activities of personnel in the managed care operations department of a healthcare facility. Oversees staff that process referrals, authorizations, billing, utilization review, and capitation for hospital services. Being a Managed Care Supervisor experienced in utilization review techniques and protocols. Requires a bachelor's degree. Additionally, Managed Care Supervisor typically reports to a manager or head of a unit/department. May require Registered Nurse (RN). Makes day-to-day decisions within or for a group/small department. Has some authority for personnel actions. The Managed Care Supervisor supervises a group of primarily para-professional level staffs. May also be a level above a supervisor within high volume administrative/ production environments. To be a Managed Care Supervisor typically requires 3-5 years experience in the related area as an individual contributor. Thorough knowledge of functional area and department processes. (Copyright 2024 Salary.com)
Under the direction of the Managed Care Director and Managed Care Manager the Managed Care Contracting Analyst will support Managed Care contracting, and maintain the development of standard and sustainable contract build, contract modeling, training, and project management related to root cause mitiation. The Managed Care Contracting Analyst is responsible for providing support to the Managed Care Contracting team, providing training to new Managed Care Contracting partners as well as ongoing training to existing Managed Care Contracting partners, and for the performance of analytic functions within the managed care contracting process, including comprehensive data analysis, financial and operational projects. Additionally, this position is responsible for building and the maintenance of managed care contractual terms within the Epic system.The Analyst will monitor the use of the Epic contracts at a high level to determine if the Payor contracts are built efficiently and on time.
Bachelor's degree in finance, business, or healthcare administration and 3 years' experience working in revenue cycle, denials management and contract management required. 8 years of experience in lieu of degree. Three years of progressive work in Contract Management is required.Exposure to project management is preferred.
Required to obtain one of the following Epic certifications: Professional Billing Reimbursement Contracts or Resolute Hospital Billing Contracts within one year.
The Special Physical Demands are considered Essential Job Functions of the position with or without reasonable accommodations.While performing the duties of this job, the employee is regularly required to walk; use hands to finger, handle, or feel; reach with hands and arms; climb or balance; stoop, kneel, crouch, or crawl; and talk or hear. The employee is frequently required to sit and work at a computer for long periods of time. The employee is occasionally required to stand. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus. While performing the duties of this job, the employee must have good manual dexterity to operate keyboard and telephone; repetitive finger/wrist movement associated with use of keyboard; prolonged sitting. The employee must be able to lift or move office related object
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