What are the responsibilities and job description for the System Contract Specialist- Managed Care position at HH Health System?
Overview
Under the general supervision of the Director Payer Contracting and Analytics, the Managed Care Specialist will work to achieve the objectives of the department including managed care contracting, financial analysis, charge capture, process improvement, project management, and staff education for specific service lines and supporting departments (revenue centers) through the organization and its affiliates. Additionally, the Managed Care Specialist will serve as a point of contact for external insurance plan representatives. Key responsibilities include interacting with Managed Care stakeholders, supporting and understanding clinical and billing processes, identifying and improving processes to allow capturing of all charges and billing for services being providing, educating and communicating with staff regarding processes, auditing and reporting outcomes of the processes, and utilizing all internal and external resources in order to accomplish and sustain improvements.The Managed Care Specialist is expected to independently lead projects and produce measureable sustained outcomes. Using national best practices, this position proactively implements and supports system Managed Care/Payer Contracting improvements.
Qualifications
Minimum Knowledge, Skills and Experience required:Education: Bachelor's in Business Administration, Health Administration, or Clinical Discipline. RN Preferred.Bachelor's Degree in Accounting, Finance, or Business field or comparable combinations of education and/or experience will be considered.Experience: At least 3 years experience working with managed care contracting, patient accounting, case management, internal audit, coding, and/or process improvement. Combination of work and educational record that demonstrates knowledge of:
- clinical and financial processes within a hospital based healthcare system
- bridging clinical and patient financial data to improve outcomes
- clear effective communication skill
- working knowledge of medical terminology, coding, and healthcare billing guidelines
- auditing, project management, and process improvement techniques
Additional Skills/Abilities: Word, Excel, PowerPoint, Access, and working within a networked IT system
