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Managed Care Specialist - Managed Care

This job posting is no longer active.

Job ID: 11832
Location: Morrisville, NC
Facility/Division: Shared Services
Status: Full Time
Shift: Day Job

Did you know UNC Health has Ranked #2 Most Trusted Healthcare Brand in the U.S.? The UNC Health brand was ranked as the #4 healthcare brand in the United States overall and the #2 most trusted healthcare brand, just after Johns Hopkins and before Mass General. Join our One-Great-Team!

Job Description


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. 

Other Information

Other information:
Education Requirements:
● Bachelor’s degree in relevant field
Licensure/Certification Requirements:
● 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:

Job Details

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

This position is employed by NC Health (Rex Healthcare, Inc., d/b/a NC Health), a private, fully-owned subsidiary of UNC Health Care System, in a department that provides shared services to operations across UNC Health Care. This is not a State employed position.
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Diversity Statement

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.

Equal Employment Opportunity

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.

To verify employment eligibility, UNC Health is committed to Form I-9 and the E-Verify process. Learn further E-Verify details in English or Spanish.

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