MANAGED CARE DEVELOPMENT COORDINATOR

The Managed Care Development Coordinator is responsible for negotiating, implementing and managing contracts with managed care organizations, insurance companies and other third party payers.

This role involves ensuring that contracts are compliant with regulatory requirements, optimizing contract terms to benefit the organization and maintaining strong relationships with key stakeholders.

The Coordinator will be key to reviewing proposed changes to reimbursement with payers in order to model and assess impact.

They will serve as a subject matter expert related to payer contract terms, requirements and expected payment.

Contract Management

o Review and analyze contract proposals, amendments and renewals

o Ensure contracts are compliant with regulatory requirements and organizational policies

o Develop and implement strategies to improve contract terms and rates

o Load payer contract terms in Managed care system, update rates as needed according to contract terms and ensure correct expected reimbursement is reflected in the patient accounting systems

o Act as subject matter expert for Patient Financial services related to contract terms, requirements and expected reimbursement

o Lead and coordinate managed care projects developing project plans, timelines and rollout

Data Analysis and Reporting

o Analyze financial and utilization data to assess the impact of managed care contracts on cash performance

o Track contract performance , including milestones, renewals, escalators and expirations to initiate actions are necessary

o Prepare reports for leadership on contract performance, including key metrics and outcomes

o Prepare rate modeling to analyze impact of proposed contracts

o Review Underpayment / Overpayment variances to determine payer trends that may need to be addressed or if modifications are needed to Managed Care contracting system

Baptist Health is the largest healthcare system serving central Alabama, providing comprehensive hospital-based and outpatient services to nearly 60 percent of the residents in Montgomery, Autauga and Elmore counties.

To learn more about Baptist Health, visit us at https : / / www.baptistfirst.org.

• Bachelor's degree in a related field or 10 years of hospital industry knowledge, hospital billing knowledge and managed care insurance claims processing experience.
• Excellent organizational and communication (written and verbal) skills; required.
• Demonstrated negotiation aptitude and analytical skills; required.
• Working knowledge of computer hardware / software (Microsoft Office Suite); required.
• Excellent interpersonal skills; required.
• Knowledge of Net Revenue and the calculation based on contracted rates for inpatient, outpatient, and Ambulatory claims.
• Expert knowledge of current reimbursement and reporting rules and regulations
• Thorough knowledge of hospital billing, collecting, and reimbursement industry standards
• Thorough knowledge of physician billing, collecting, and reimbursement industry standards
• Knowledge of the regulations related to Medicare and Medicaid, patient rights, compliance, and other related areas
• Knowledge of professional business and communication practices including spoken and written communication
• Ability to articulate thoughts and concepts in a professional manner
• Ability to successfully complete work within time constraints with the ability to multi-task
• Ability to review key performance indicators, identify opportunities, and implement improvement plans
• Ability to create a collaborative environment and promote relationship based care ideas
• Analytical and problem solving ability and attention to detail are important
• Must be able to perform basic mathematical calculations, balance and reconcile figures, punctuate properly, spell correctly and transcribe accurately
3 days ago