Key Facts

Remote From:

Full time

Mid-level (2-5 years)

English

Hard Skills

Managed Care Medicaid Management Information Systems (MMIS) Contract Management Revenue Management Health Reimbursement Arrangement ICD Coding (ICD-9/ICD-10) SQL (Programming Language) Billing Contract Management Business Computer Systems Accounts Receivable Claims And Litigation Management Medical Expense Performance Reporting Systems Safety Standards Continuous Improvement Process

Other Skills

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Microsoft Excel
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Analytical Skills
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Client Confidentiality
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Communication
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Adaptability
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Analytical Skills
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Basic Reading
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Teamwork
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Customer Service
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Organizational Skills
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Writing
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Typing
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Logical Reasoning
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Problem Solving

Roles & Responsibilities

High School Diploma or GED
Four (4) years of related managed care contracting and/or billing/collection experience in a hospital and/or managed care payor setting
Proficiency with Microsoft Excel and other spreadsheet systems, knowledge of Patient Accounting Systems, and familiarity with SQL; understanding of billing practices including revenue codes, CDM codes, and ICD-9 codes

Requirements:

Perform complex managed care financial analyses and support Revenue Cycle operations, including interpreting and updating Managed Care Contracts and related systems
Assist with contract negotiation processes, provide recommendations to negotiators, and act as a liaison between contract management system administrators, Revenue Cycle, and Managed Care negotiators
Pursue payments from payers and collaborate with managed care payors to resolve claims and improve contract performance
Identify opportunities for process improvement, ensure confidentiality and safety compliance, and facilitate cross-department coordination for managed care modeling and reimbursement system feedback

Job description

Job Category:

Accounting & Finance

Work Shift/Schedule:

8 Hr Morning - Afternoon

Northeast Georgia Health System is rooted in a foundation of improving the health of our communities.

About the Role:

Job Summary

Performs a wide range of complex managed care analytical and operational functions. Performs office procedures in support of managers. This position is responsible for managed care financial analysis. This person will also assist with contract negotiation processes as needed, make recommendations to the Managed Care negotiators regarding terms of the contract. This person will act as a liaison between contract management system administrators, Revenue Cycle, and the Managed Care negotiators for resolution and feedback of any related items. This person will work with managed care payors to resolve claims and related issues in order to enhance managed care contract performance.

Minimum Job Qualifications

Licensure or other certifications:
Educational Requirements: High School Diploma or GED.
Minimum Experience: Four (4) years of related managed care contracting and/or billing/collection experience in a hospital and/or managed care payor setting.
Other:

Preferred Job Qualifications

Preferred Licensure or other certifications:
Preferred Educational Requirements:
Preferred Experience:
Other:

Job Specific and Unique Knowledge, Skills and Abilities

Knowledge of Microsoft Excel and other spreadsheet systems
Knowledge of the Patient Accounting Systems.
Knowledge in Managed Care or similar reimbursement area
Knowledge of SQL programs, understanding of billing practices, specifically revenue codes, CDM codes, and ICD-9 codes
Excellent organizational and communication skills
Must have knowledge of contract negotiation process
Must be able to apply mathematical and analytical skills
Exemplifies the organization's customer service standards
Improves work processes
Meets all mandatory educational requirements
Complies with confidentiality rules, polices, and regulations in all aspects of the job
Demonstrates working knowledge of safety practices
Promotes teamwork
Meets NGHS attendance standards
Utilizes financial resources effectively
Responds positively to change regarding work
Demonstrates respect for co-workers

Essential Tasks and Responsibilities

Able to understand and interpret Managed Care Contracts.
Ability to accurately update the Managed Care Systems, and when required, the Business Office Legacy System.
Pursue payment from payers.
Customer Service/Continuous Improvement.
Posses a specific knowledge of Third Party Healthcare Arrangements and is able to apply that knowledge.
Must be able to calculate and audit expected reimbursement in order to determine accuracy of payment.
Must be willing to learn and act as a “System Administrator.”
Must be able to make the appropriate payment classifications determination and record it accurately in the system.
Continually seeks ways and means for improving the delivery and support of Managed Care Modeling & Reimbursement System feedback.
Is aware of process flow(s) across all Revenue Cycle departments, and involves them, as appropriate, when recommended actions may impact their work functions.

Physical Demands

Weight Lifted: Up to 20 lbs, Occasionally 0-30% of time
Weight Carried: Up to 20 lbs, Occasionally 0-30% of time
Vision: Heavy, Frequently 31-65% of time
Kneeling/Stooping/Bending: Occasionally 0-30%
Standing/Walking: Occasionally 0-30%
Pushing/Pulling: Occasionally 0-30%
Intensity of Work: Occasionally 0-30%
Job Requires: Reading, Writing, Reasoning, Talking, Keyboarding

Working at NGHS means being part of something special: a team invested in you as a person, an employee, and in helping you reach your goals.

NGHS: Opportunities start here.

Northeast Georgia Health System is an Equal Opportunity Employer and will not tolerate discrimination in employment on the basis of race, color, age, sex, sexual orientation, gender identity or expression, religion, disability, ethnicity, national origin, marital status, protected veteran status, genetic information, or any other legally protected classification or status.

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