Managed Care Coordinator coordinates utilization reviews of managed care contracts using established guidelines and processes. Ensures all clinical operations comply with Medicare and Medicaid guidelines and other managed care policies. Being a Managed Care Coordinator communicates with physicians, discharge planners and others to process referrals, authorization for services, and capture data related to utilization. Maintains managed care contracts and information databases and prepares reports. Additionally, Managed Care Coordinator typically requires an associate degree in nursing. Typically reports to a supervisor or manager. Typically requires Registered Nurse (RN). The Managed Care Coordinator has gained full proficiency in a broad range of activities related to the job. Independently performs a wide range of complex duties under general guidance from supervisors. To be a Managed Care Coordinator typically requires 5-7 years of related experience. (Copyright 2024 Salary.com)
Summary
SUMMARY: Under the direction of the Reimbursement and Managed Care Analytics Director, the Managed Care Analyst is responsible for helping ensure the financial health of North Kansas City Hospital (NKCH) and Meritas Health through support of enterprise managed care activities. Responsibilities include the following:
EXPERIENCE: Minimum 2 years of experience in a Health System or Managed Care Organization (MCO), with demonstrated experience in healthcare analytics. Demonstrated experience in problem-solving and project management.Experience with contract management and modeling software, managed care principals, hospital and professional coding, reimbursement, and financial terms such as DRG, CPT, HCPCS, ICD-10, APC, ASC groupers, chargemaster, revenue codes and payor policies preferred. Experience with Cerner Patient Accounting preferred.
SPECIAL SKILLS: Highly skilled in data collection, data analysis (Power BI), advanced Excel knowledge (including pivot functionality and advanced formulas), and relational databases. Experience with database extraction of patient accounting, medical records, and patient healthcare record data. Knowledge of hospital and physician reimbursement methodologies (i.e. DRG, per diem, fee schedule, APC). Working knowledge of billing/coding terminology (i.e. ICD-10, CPT, Revenue codes).
OTHER: Excellent organization and attention to detail required; ability to communicate complex information to various audiences; ability to work in a fast-paced environment; ability to problem-solve issues where analysis is required; decisions and actions have direct impact on hospital financials; ability to work independently, and as part of a team. The ability to multitask and prioritize multiple tasks to meet deadlines. Takes ownership of job, proactively responding to commitments. Takes specific actions to improve own work methods or systems. Develops and implements new and unique ideas.
LICENSE/CERT: Preferred: CCS (Certified Coding Specialist)
EDUCATION: Required: Bachelors - Business, Bachelors - Finance, Bachelors - Accounting, Bachelors - Health Care Management