Assist USPI facilities and Central Billing Offices with escalated claims resolutions.
Coordinates, educates, monitors, and ensures accurate implementation of complex managed care contracts for each USPI facility and Central Billing Offices (CBO) for a given region.
Acts as a contract liaison and expert by providing timely and accurate information, as well as education, to internal and external customers to optimize managed care strategies and maximize financial profitability.
Responsible for projects improving operational effectiveness.
Utilizes tools to trend issues and ensure contract compliance.
Supports the activities of managed care contracting for USPI in support of policies, goals and objectives established by the Director of Managed Care Operations.
Monitors the performance of managed care contracts to ensure accurate claims processing; including level of underpayments and overpayments by providers.
Builds relationships with internal (CBO, admissions, medical management, physicians etc.) and external (contracted payors, physician practices) customers by promoting open dialogue to create "win-win" solutions and outcomes to operational challenges.
Helps facilities resolve claims issues through Service Now.
Work with Regional Director of Managed Care on special projects, as assigned.
Ensure the operational efficiency of negotiated contract terms.
Suggest ways to improve financial and operational efficiency of existing contracts.
Review contracts and provide insight on how to minimize the need for administrative resources to collect revenue for new contracts.
Participate in negotiating as assigned.
Assist Regional Director in ensuring that facilities receive timely updates on new agreements.
All other duties as assigned.
Managed Care Assist - Building and maintaining a resource for information sharing and continuous education between facilities and USPI Managed Care.
Educate – Work closely with USPI facilities to provide insight on using the contract and payor resources to avoid claim denials.
Provide facilities with updates to payor policies that may have a meaningful impact on their operations.
Work closely with counterparts to help identify payment trends and communicate those to the department/facilities.
Position based in DFW
Ability to travel as needed - up to 45% during peak seasons
1. A keen understanding of managed care contract provisions and ambulatory surgery center and/ or hospital reimbursement.
2. Excellent organizational, decision making, communication, and relationship building skills, both written and verbal.
3. Strong financial analysis skills required.
4. Strong computer skills in MS Word, MS Access, MS Excel, and MS PowerPoint required.
1. Bachelor’s Degree (preferred) or equivalent years of service.
2. At least 3 years’ experience in health care market performing managed care contracting, provider relations, or payer relations duties.
Irving, Texas, United States
Irving Regional Office (111111)