Top Managed Care Executive jobs in Rockford, IL

Overview

• Managed Care Contract Analyst, Days, 80 Hrs / 2 wks
• Location: Mercycare Bldg, Janesville, WI OR Rockton Ave Campus, Rockford, IL. Hybrid, flexible work schedule, and remote opportunities available. Mercyhealth does not currently support remote workers with residency in the following states: CA, OH, OR, PA, NJ, NY.

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.

Responsibilities

• Provides contracting support for Mercyhealth managed care contracting initiatives, to include review of all contract and amendment proposals. Assists with providing oversight for all managed care contractual terms building, testing, and production within Epic or other ancillary systems. Provides support for contract negotiations, including measurement of results. Serves as subject matter expert with regards to Mercyhealth managed care contracts.
• Works corroboratively with system-wide personnel in the implementation of system managed care agreements. These duties may include but are not limited to identifying training needs, reporting needs, and the ongoing management and administration of agreements.
• Builds and maintains all current and updated managed care contractual terms within Epic; tests all ongoing models to assure contract payment accuracy and integrity. Monitors creation and completion mapping for all new payer/plans for Mercyhealth in Epic. Interfaces with other Revenue Cycle areas to identify and resolve issues. Provides recommendations for Epic contract maintenance and the development of new tools to support contracts and model build.
• Collaborates with all Revenue Cycle and other areas on researching and resolving contract variances and discrepancies. Works the various underpayment and overpayment work queues, and submits reconsiderations and/or appeals as necessary. Consults as needed with clinical and operational teams on managed care initiatives. Leads consulting efforts with the Information Systems department regarding Epic contracting.
• Provides training to new partners, and provides ongoing training to existing partners within the Managed Care Contracting department. Assists in the development of departmental training materials.
• Performs audits of contract build in Epic.
• Keep current of ICD-10 and CPT coding requirements
• Content expert for contract terms and all payment methodologies for hospital, physician, and ancillary entities (DRGs, APCs, RUGs, surgical groupers, service line careveouts, physician fee schedules, locality indexes, and all cost reports
• Participates in educational programs to meet mandatory requirements and identified needs with regard to position and personal growth.
• Additional duties as assigned or appropriate

Education and Experience

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.

Certification/Licensure

Required to obtain one of the following Epic certifications: Professional Billing Reimbursement Contracts or Resolute Hospital Billing Contracts within one year.

Special Physicial Demands

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

Culture of Excellence Behavior Expectations