Manager, Managed Care Contracts

Patient Financial ServicesCentral Business Office Dalton, Georgia


Description

Hamilton Health Care System, Inc.

Job Description and Performance Standards

Title:  Managed Care Contracts Manager 339005703

Department:  Centralized Business Office

Reports To:  Director, Centralized Business Office

Shift:  8:30am-5:00pm Monday-Friday 

Status:  Full Time

JOB SUMMARY

This position is responsible for the overall maintenance and management of the Soarian Financials third party payer contract management system and contract variance reporting and analysis.  Provides support to management in the negotiation of major third party payer contracts through data extraction and development of complex reimbursement modeling.  Identifies and follows up on insurance underpayments.  Maintains and updates the Soarian Financials Health Provider Organization, Payer Organization and Payer Health Plan Master Files.  Assists with contract modeling as needed.  Stays updated on all payer billing and reimbursement changes and communicates to the CBO and Patient Access teams accordingly.

JOB QUALIFICATIONS

Education:  Bachelor’s Degree with some accounting or finance experience required.  HFMA Managed Care Certification preferred.

Licensure:  N/A

Experience:  At least 3-5 years of health care contract management experience required.  Experience with Soarian Financials is preferred.  Experience with CPT, ICD-9, and modifiers is essential.  Basic knowledge of hospital Medicare and Medicaid fee schedules and reimbursement mechanisms.  Experience with and knowledge of hospital third party billing requirements, claim payment methodologies, claim system requirements, procedures and controls.  Good understanding of third party payer contract language and reimbursement terms. 

Skills:  Proficient in Word and Excel.  Power Point and Access experience is beneficial.  Proven excellence with oral and written communications.  Strong attention to detail and possess a high analytical ability.  Skilled in contract management software and/or adequate technical ability to learn this type of system.

PHYSICAL, MENTAL, ENVIRONMENTAL AND WORKING CONDITIONS
Typical office setting.  Required to work on PC and/or CRT terminal approximately 80% of the workday.  Limited travel for education and training.

Moderate amount of sitting with some stooping, lifting, or bending.  Must be able to meet deadlines and handle large work volumes.  Ability to exercise good business judgement.