Facility

Cape Fear Valley Medical Center

Location

Fayetteville, North Carolina

Department

Managed Care Planning

Job Family

Clerical

Work Shift

Days (United States of America)

Summary

Assist in developing, implementing and maintaining contractual relationships as well as take lead on other projects.

Major Job Functions

The following is a summary of the major essential functions of this job.  The incumbent may perform other duties, both major and minor, that are not mentioned below.  In addition, specific functions may change from time to time:

• Assist and, in some cases, lead negotiating and maintaining managed care contracts

• Coordinate reporting that analyze reimbursement methodologies and rates to determine payment accuracy

• Assist in developing, implementing and maintaining a system of renewal and reporting to monitor the status, performance and viability of contracts

• Work with internal and external stakeholders to ensure appropriate and timely loading of contract changes

• Monitor Managed Care websites for any change in policy

• Work with PFS to determine appropriate claims for escalation

• Work with Payers on appeals of denial

• Maintain, monitor and report on managed care recoupment activities

• Work with Client billing lists to ensure contracts are being reimbursed

• Maintain and validate third-party commercial refund requests

• Other duties as assigned

Minimum Qualifications

The following qualifications, or equivalents, are the minimum requirements necessary to perform the essential functions of this job:

Education and Formal Training: 

• High school diploma or equivalent required

• Bachelor’s degree preferred OR 8 years of experience preferred

Work Experience: 

• 3 years medical business experience in a related field or managed health care experience preferred

• Experience working directly with employers, insurance companies and/or physicians is strongly preferred

Knowledge, Skills, and Abilities Required: 

• Proficiency in reading, writing, and speaking the English language

• Proficiency with personal computer, electronic calculator, fax machine and copy machine

• Excellent interpersonal skills with the ability to interact with hospital management, physicians and outside organizations

• Ability to be effective with little to no day-to-day supervision

• Possess and demonstrate strong written and verbal skills, be results oriented, and exemplify a team player attitude

• Strong analytical and financial skills to determine the potential economic impact of relationships, contracts and contract alternatives

• Ability to demonstrate effective leadership traits and competently execute decisions

• Ability and willingness to work on a variety of activities and projects

• Ability to work with people in a tactful, diplomatic manner

Physical Requirements: 

• Present a professional and executive image to effectively present proposals and favorably influence clients

• Position requires a flexible schedule

Required Licenses and Certifications

Cape Fear Valley Health System is an Equal Opportunity Employer M/F/Disability/Veteran/Sexual Orientation/Gender Identity