Managed Care & Payer Rel Supv

Managed Care & Payer Relations

Full Time

Day Shift

8

Consistently named best hospital, Lexington Medical Center dedicates itself to providing quality health services that meet the needs of its communities. Ranked #1 in the Columbia metro area by U.S. News & World Report, Lexington Medical Center is the only hospital named one of the Best Places to Work in South Carolina and the first hospital in the state to achieve Magnet with Distinction status for excellence in nursing care.

The 607-bed teaching hospital anchors a health care network that includes six community medical centers and employs more than 8,700 health care professionals. The network includes a cardiovascular program recognized by the American College of Cardiology as South Carolina’s first HeartCARE CenterTM and an accredited Cancer Center of Excellence affiliated with MUSC Hollings Cancer Center for research and education. The network also features an occupational health center, the largest skilled nursing facility in the Carolinas, an Alzheimer’s care center and nearly 80 physician practices. Its postgraduate medical education programs include family medicine and transitional year.

Job Summary

Provides day-to-day leadership to the Payer Reimbursement Representatives. Manages the performance and productivity of the managed care contract compliance system. Ensures accurate and timely identification and recovery of "short pays/underpayments" from contracted & non contracted insurance payers. Identify patterns or recurring trends with payers that consistently do not reimburse in accordance to contracts and communicate this information to the appropriate parties (Manager, Director, Payer Representatives, etc.).

Minimum Qualifications

Minimum Education: High School Diploma or Equivalent

Minimum Years of Experience: 8 Years of experience in managed care finance.

Substitutable Education & Experience: 8 Years of experience can be substituted with a Bachelor's Degree in a business related field and 3 years of experience in managed care finance

Required Certifications/Licensure: None.

Required Training: Ability to manipulate data in spreadsheets in order to report trends/patterns/statuses or abuses to Manager;

Working knowledge of managed care terminology and reimbursement methodologies;

Procedural knowledge of hospital or physician practice accounts receivable management and/or revenue cycle, and billing/coding terminology.

Essential Functions

• Exercises direct supervision of Payer Reimbursement Representatives. Coordinates workloads and workflows. Interviews, hires and trains new employees. Evaluates and counsels employees on work performance and attendance, recommends merit increases, promotions, and term.
• Ensures accurate identification and timely recovery of hospital and physician practice underpayments by insurance payers.
• Maintain a high level of professionalism while aggressively pursuing underpayments by third party payers.
• Will communicate appropriate data to Manager of Managed Care & Payer Relations for purposes of new contract negotiation or re-negotiation of existing contracts.
• Will be responsible for creating a follow up system to maintain accountability of underpaid accounts.
  
  

Duties & Responsibilities

• Ensure proper documentation of activity or progress in Facility and Professional billing applications and contract management software to ensure that anyone viewing accounts will be aware of current status.
• Manipulate data to report monthly recovery status.
• Monthly reporting of consistent underpay patterns/trends or abuses.
• Mediate meetings with contracted payer representatives related to trends or patterns of underpayments.
• Act as a resource for hospital and physician practice staff as it relates to questions/concerns regarding managed care payers.
• Performs all other duties as assigned by Manager.
  
  

We are committed to offering quality, cost-effective benefits choices for our employees and their families:

• Day ONE medical, dental and life insurance benefits
• Health care and dependent care flexible spending accounts (FSAs)
• Employees are eligible for enrollment into the 403(b) match plan day one. LHI matches dollar for dollar up to 6%.
• Employer paid life insurance – equal to 1x salary
• Employee may elect supplemental life insurance with low cost premiums up to 3x salary
• Adoption assistance
• LHI provides its full-time employees employer paid short-term disability and long-term disability coverage after 90 days of eligible employment
• Tuition reimbursement
• Student loan forgiveness
  
  

Equal Opportunity Employer

It is the policy of LMC to provide equal opportunity of employment for all individuals, and to remain compliant with applicable state and federal laws and regulations. LMC strives to provide a discrimination-free environment, and to recruit, select, on-board, and employ all employees without regard to race, color, religion, sex, age, disability, national origin, veteran status, or pregnancy, childbirth, or related medical conditions, including but not limited to, lactation. LMC endeavors to upgrade and promote employees from within the hospital where possible and consistent with the employee’s desires and abilities and the hospital’s needs.

Nearest Major Market: Columbia

Nearest Secondary Market: South Carolina