Job: Manager - Managed Care

Title: Manager - Managed Care
Location: US-GA-Decatur (DeKalb Medical at North Decatur)
Employee Type: Full Time
Department: 409110 - Managed Care Contracting
Shift: Day
Other Shift: ..

Days of the Week for Employee: Monday - Friday

Other Days of the Week: ..

Street: DeKalb Medical at North Decatur

More information about this job:

Responsibilities:
Summary of Position: The Manager position will be responsible for leading the Managed Care Department's day to day activities both internal and external with minimal supervision from the Executive Director. Key components of this responsibility include identifying, analyzing and managing Managed Care projects such as contract renegotiations, modeling, auditing, credentialing, interdepartmental workgroups, contract maintenance and many more. The Manager will be the key contract with all relevant groups including, Patient Access, Coding, Billing, Collections, Clinical Departments and Managed Care Payors. The Manager will have minimal supervision on an ongoing basis and must operate independently. This Manager will lead, under the supervision of the Executive Director, all managed care relationships including ongoing and future negotiations with the payors. The Manager must also be able to identify potential revenue and/or compliance issues with respect to Managed Care. This can be accomplished either from data manipulation or observations. The Manager will be responsible for querying all data sources and knowledge sources within DeKalb Medical including, but not limited to Decision Support System, Patient Accounting System, Contract Management and Clinical Systems. The Manager will also be responsible for any data manipulation in Excel or Access as required and the preparation and presentation of that data to the proper departments in the hospital. The Manager will have direct interaction with all Managers, Department Heads, VPs, SVPs and CEO regarding Contracting and Process Improvement Projects. It is essential that this Manager have previous project management skills to manage and facilitate team projects. Essential Functions of Role: Management of daily activities and staff of Managed Care DepartmentSupervise work of Managed Care Team including Systems Coordinator, Analyst and team of Specialists. Reporting information as needed or requested to leadershipManaging all data preparation, proposal delivery and face to face contract negotiations under supervision of Executive DirectorObserve and develop an in-depth understanding of revenue cycle operations
- Patient Access, Managed Care, Care Management and Patient Accounting so as to become the internal resource for managed care information with the systemProactive identification of managed care and revenue cycle opportunities at all levels of the organization.Active involvement and extensive leadership of multiple projects at one timeManipulation of highly complex data sets and process flows in standard software packages
- Access, Excel, PowerPoint, Crystal, etc.Stays abreast and informed of payer correspondence that impacts the administration of the contract terms. Communicates such changes/correspondence with appropriate departments . Develops formal process and policy for review of managed care contracts.Meets regularly with payer representatives for top five payers to maintain positive working relationships and resolve disputes.Other projects or activities as assigned by leadershipReports to: Executive Director, Managed Care & Ventures Direct Reports: Will manage a team of 5-8 employees.

Minimum Qualifications Bachelor's degree with health management or financial emphasis and/or health services with a master's degree preferred.At least seven (7) years of progressive healthcare management experience, preferably in a managed care setting within a hospital or payorDeep understanding of Database, Spreadsheet and Word Processing programsUnderstanding of Crystal Reporting is desirableAbility to understand the data sets available for hospital financial research - including but not limited to CMS bulletins, medical records, financial systems, HFMA reports... Highly successful communication abilities in written, spoken and presentation format.Strong multiple project leadership abilities including management through persuasion. Clear illustration of knowledge of best practice revenue cycle operations. Strong teamwork experience and interest. Additionally, working knowledge in the areas of patient registration, billing, accounts receivable (AR) and cash management requirements, managed care contractual terms and requirements, health insurance practices, industry regulatory requirements, business office operations, AR and financial reporting technology, wage and hour regulations, charge description master systems and compliance, denials and underpayment management, basic accounting, and industry standards for healthcare revenue resolution management practices.


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