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Job ID: 11832
Location: Morrisville, NC
Facility/Division: Shared Services
Status: Full Time
Shift: Day Job
Become part of an inclusive organization with over 40,000 diverse employees, whose mission is to improve the health and well-being of the unique communities we serve.
The Managed Care Specialist will work as part of the Contract Administration Team responsible for supporting various Hospital Billing functions within our organization. These include, but are not limited to, setting up reimbursement calculations, performing payment variance analysis, supporting Ad-Hoc reporting requests, and providing contract negotiation support. Opportunity for remote work.
The Managed Care Specialist will be involved in the following activities as part of the Contract Administration Team:
1.) Maintaining expected Hospital Billing reimbursement calculations in the Epic Contract Engine. UNC Health uses the Epic HIS tools to support the expected reimbursement calculations for Hospital Billing. Calculations are performed for Facility, Home Health, Hospice, Ambulatory Surgery, and Skilled Nursing Facility reimbursement. These calculations are supported for both Governmental based as well as Commercial Payors. Tasks are performed to ensure both the Epic system and the Payor’s systems are loaded correctly.
2.) Supporting contract modeling scenarios as part of major payor negotiations. Using tools developed in the Managed Care department, proposed rates from Commercial payors are modeled for all UNC Health to verify the expected yield for our health system. These models are summarized so that they can be presented to the financial leaders across the health system.
3.) Assisting Patient Financial Services with variance analysis. Regular meetings are scheduled with all entities to review payment activity to ensure accuracy and performance.
4.) Fulfilling Ad-Hoc reporting requests. Using the Business Objects and Tableau applications we are responsible for completing various requests for our health system.
● Bachelor’s degree in relevant field
● No licensure or certification required.
Professional Experience Requirements:
● If a Bachelor's degree, requires two (2) years of experience with managed care contracts, data analysis or provider relations. If Associate’s degree, requires six (6) years of experience with managed care contracts, data analysis or provider relations. If High School diploma or GED, requires ten (10) years of experience with managed care contracts, data analysis or provider relations.
Knowledge/Skills/and Abilities Requirements:
Legal Employer: NCHEALTH
Entity: Shared Services
Organization Unit: Managed Care
Work Type: Full Time
Standard Hours Per Week: 40.00
Work Schedule: Day Job
Location of Job: US:NC:Morrisville
Exempt From Overtime: Exempt: Yes
The UNC Health System and the UNC School of Medicine are committed to valuing all people throughout our organization, regardless of background, lifestyle, and culture. A diverse and inclusive work environment for staff and culturally appropriate care for our patients, are essential to fulfilling our UNC Health vision of improving the health of all North Carolinians.
UNC Health is an equal opportunity employer. As such, UNC Health offers equal employment opportunities to applicants and employees without regard to race, color, religion, sex, national origin, age, genetic information, disability, sexual orientation, gender identity or political affiliation.