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Job ID: 14366
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 Coordinator manages the contracts for payers such as BCBS, United Healthcare, Cigna, Aetna, etc. The Managed Care Coordinator position is a mid-level analyst who will be building Excel financial models using current utilization and payer reimbursement rates as well as reporting on payer performance and performing other ad hoc analysis. Useful skills would include Excel, Business Objects, Tableau, Strata, etc.
1. Managed Care Analysis- Identifies management information needs; researches and analyzes data to provide necessary information to leadership positions. Analyzes financial, contractual, and operational issues related to contracted payers. Knowledge of Business Objects, Strata, and/or Tableau a plus. Must be proficient in Excel.
2. Contract Negotiation- Evaluates and models financial and operational terms of proposed managed care agreements with various payers, including state and federal correctional groups, commercial behavioral health, hospice, various county health departments, and contracts for specific service lines. Presents contract challenges to Health leadership. Consults with internal subject matter experts to resolve contracting roadblocks. Utilizes internal and external sources of information to improve contracting efforts and essential contract content, including use of appropriate negotiation techniques. Helps maintain rate files for use in analysis, variance calculations, pro formas, etc.
3. Provider Relations- Helps manages various managed care contractual relationships, assisting with communication, contract compliance, problem resolution, legal issues, etc.
The preferred candidate will have dealt with insurance companies and financial contracts and not managing individual patient care.
● 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 and provider relations. If Associate’s degree, requires six (6) years of experience with managed care contracts and provider relations. If High School diploma or GED, requires ten (10) years of experience with managed care contracts and 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.