Manager Managed Care

Summary:

This position is responsible for managing daily activities as assigned by System Director or Director related to providing operational support on managed care contracts. The candidate will be responsible for working directly with managed care payers and PFS to resolve claim payment and administrative escalations occurring with managed care contracts. Responsible for the mentoring and training of team members as needed, providing subject matter expertise to improve efficiencies and results. The candidate will work collaboratively with Vice President Managed Care, Managed Care Team, Revenue Integrity, and PFS management.

Responsibilities:

• Assists the point person to the hospital leadership teams and business offices for the assigned CHRISTUS region(s) for all managed care related aspects, including contract performance and operational issues Carries out appropriate managed care related education and training including roll out of new payor contracts
• Assists in payor/plan dispute resolution projects or any other special projects
• Responsible for coordinating payer credentialing & re-credentialing activities
• Works with the hospital business offices with regard to tracking and reducing managed care denials and underpayments, including restitution or other prompt pay penalties
• Knowledge of Federal and Texas general regulatory environment related to managed care and participates in legislative advocacy activities as appropriate
• Monitor implementation managed care contracts for all CHRISTUS Health Providers
• Develop payer performance and monitoring tools
• Conduct data analyses/reports to the assigned System Director or Director on payments and operational issues associated with Managed Care contract language

Requirements:

• Bachelor's Degree preferred

Work Type:

Full Time