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MANAGED CARE SPECIALIST - MANAGED CARE

UNC Health Care
Chapel Hill

Job Description

This position may involve support of various hospitals and health care systems within the UNC Health Care System, but will be employed by Rex Hospital, Inc. (this includes, but is not limited to, for purposes of payroll, health benefits, retirement options, and applicable policies). If selected candidate is currently employed with UNC Health Care System the candidate will stay on current payroll and benefits platform.

Essential Job Duties

Contract set up in Epic is a very involved process which requires the understanding of patient accounting and contract terminology as well as the use of some elements of programming skills. Many of our contracts are very complicated and difficult to set up and maintain. It is essential to maintain the accuracy of our contract set up in the Epic system to prevent potentially significant financial repercussions.

This position will be responsible for:

Setting up and updating contract terms and ensuring the integrity and accuracy of the contract terms in the Epic Contract Management system;
Developing expert knowledge of payment terms in managed care contracts and the ability to model and test those terms appropriately in the Epic contract management system;
Developing and using reporting mechanisms to identify and correct reimbursement term set errors in a timely fashion;
Providing contract language and reimbursement information at other departments request
Attending payers meeting to obtain information and policy that has an impact on contract reimbursement and work with managed care office to resolve issues;
Working with EPIC Technical Support, internal ISD and other departments to resolve issues that have an impact on contract reimbursement;
Reviewing contract enhancement during and after EPIC upgrade;
Ensuring that Epic variance work queues are set up appropriately and reflect true variances;
Retrieving and analyzing contract management data, developing management reports and evaluating expected and actual payment information using Business Objects;
Identifying patient accounts in which payments have not been made in accordance with contract terms;
Investigating the causes of payment variances and identifying underpayment and overpayment trends;
Providing Excel spreadsheets of payment variances to team members who work the variances;
Explaining contract terms to team members who recoup underpayments and review overpayments;
Using Epic patient accounting application system to investigate and resolve under payment issues by comparing explanations of benefits to contract payment terms;
Working with managed care insurance company reimbursement personnel and UNC Managed Care department personnel to resolve payment discrepancies to recoup underpayments;
Providing training and assistance to the FSS Specialists in all aspects of the Epic application and the contract management and under payment recoupment business processes associated with this application.

Qualifications

Bachelors degree in relevant field. Requires two (2) years of experience with managed care contracts, data analysis or provider relations.

If Associates degree, requires six (6) years of experience with managed care contracts, data analysis or provider relations.

If High School degree, requires ten (10) years of experience with managed care contracts, data analysis or provider relations.

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