Managed Care Specialist

• Responsible for the contract build in the EMR and serves as the subject matter liaison for any external contract variance tools or systems

• Identify, track, trend, and provide root cause of payor variances

• Prepare necessary documentation that allows for the collections of those variances

• Educate key stakeholders on actions needed to eliminate variances, when variances are due to internal processes i.e. coding, billing etc.

• Assist Provider Enrollment with analytics needed, trending payor response times, application denials/delays by payors

• Work with leaders to identify areas of revenue loss by service/CPT, identifying lesser-of

• Review and monitor contractual allowance calculations and variances in expected reimbursement. Identify origin of variance (under/over payment) or modeling discrepancies and perform routine root cause analysis to identify system and/or contract modeling errors

• Provide ongoing support and tools for internal and external customers related to MVP's Managed Care

• Collaborate with key stakeholders to ensure appropriate facility/ASC credentialing needs are addressed

• Analyze data, providing trending and identify root cause within Managed Care and Credentialing

• Resolution and collection of variances by making calls to the payer, appeals, portal appeals, written appeals, payor calls etc.

• Collection and maintenance of payer correspondence and bulletins. Effectively communicating updates/changes to internal customers

• Develop SOPs for consistency and alignment with company goals

• Perform other duties as assigned

• Communicate effectively with all stakeholder groups to review performance, discuss issues impacting financial performance, share information and key updates, and provide education:

• Exemplary working knowledge and interpretation of provider and payor contracts and fee schedules to determine valid variances

• Excellent written and verbal communication skills

• Highly organized, dependable, and focused on quality and service

• Self-directed, metrics minded, and unafraid of challenging the status quo

• Demonstrated teamwork skills and the ability to work with different teams, entities

• Proficiency using Microsoft Office, such as Outlook, Word, Excel, and PowerPoint

• High ethical standards

• Ability to work with a high attention to detail

• Bachelor's degree in finance or business-related a plus; or commensurate experience

• 5+ years in payer relations/contracts/fee schedules aiding in payment variance identification and resolution or related industry experience

Midwest Vision Partners