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Managed Care Coordinator
Greensboro, NC
Job Description
Managed Care Coordinator
ID
2023-21218
| Location | Cone Health | Work Location | US-NC-Greensboro | Division : Name | Finance | Department : Name | SW-Pt Acct Rev Integrity | Category | PROFESSIONAL/MNGMNT | Position Sub-Category | PROFESSIONAL/MNGMNT | Position Type | Full Time (40 hours/week) | Employment Type | Employee | Exempt/NonExempt | Exempt | FTE | 1.00 | Workforce Status | Hybrid I | Work Hours | 40.00 | Provider Schedule (specific schedule) | M-F, 8-5 | On call Required | No | Sub Category | Professional/Management |
| This position is responsible for accurately analyzing, implementing and monitoring contractual relationships in support of Managed Care goals and objectives. Serves as a liaison between, Cone Health, Carolinas Health System and payers to accurately administer Managed Care contract terms, resolve problems, troubleshoot and provide customer service. |
Talent Pool: Corporate Services/Professional
| Implement the startup of newly negotiated managed care contracts. Oversee operational relationships with established managed care contractors. -------------------------------------------------- Serve as an internal resource to operating divisions/departments in the interpretation and implementation of current and revised contract provisions. Manage the flow of information to the appropriate staff and facilitate problem resolution. -------------------------------------------------- Assist with coding of contract databases, development, performance, and documentation of tasks for the appropriate contract management applications. -------------------------------------------------- Coordinate electronic access to payer websites for Health System staff. -------------------------------------------------- Monitors/trends contract/payer performance and outcomes for purposes of compiling summary data for administrative and managerial review. -------------------------------------------------- Works with denial team and underpayment team to coordinate/administer appeal efforts for reimbursement not made in compliance with contract terms. -------------------------------------------------- Assist in certain managed care efforts for hospital based staff physicians, psychologists and other professional providers. -------------------------------------------------- |
| EDUCATION: |
| Associates, Business Administration, Required Bachelors, Business Administration, Preferred Associate Degree in Business Administration, Accounting or a related field or equivalent work experience required; Bachelor's Degree preferred. |
| EXPERIENCE: |
| 3-5, Required 6-7, Preferred Minimum of 3-5 years in a medical/insurance environment; 6-7 years preferred. Health Information Management with electronic medical records and EPIC experience preferred. |
| LICENSURE/CERTIFICATION/REGISTRY/LISTING: |
| REQUIRED N/A PREFERRED N/A |
Cone Health is an Equal Opportunity Employer and committed to providing equal opportunity employment opportunities for applicants and employees. All employees and applicants for employment will be evaluated on the basis of their qualifications, ability, and performance without regard to race, religion, age sex, sexual orientation, gender identity, veteran's status, ethnicity, national origin, disability, color, or as otherwise protected by law.
Job Summary
Company
Start Date
As soon as possible
Employment Term and Type
Regular, Full Time
Required Experience
3 to 5 years
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