Manager Managed Care Contract & Operations

Baylor Scott & White Health • Dallas, TX • 13h ago

About Us

Here at Baylor Scott & White Health we promote the well-being of all individuals, families, and communities. Baylor Scott and White is the largest not-for-profit healthcare system in Texas that empowers you to live well.

Our Core Values are:

We serve faithfully by doing what's right with a joyful heart.

We never settle by constantly striving for better.

We are in it together by supporting one another and those we serve.

We make an impact by taking initiative and delivering exceptional experience.

Benefits

Our benefits are designed to help you live well no matter where you are on your journey. For full details on coverage and eligibility, visit the Baylor Scott & White Benefits Hub to explore our offerings, which may include:

Immediate eligibility for health and welfare benefits

401(k) savings plan with dollar-for-dollar match up to 5%

Tuition Reimbursement

PTO accrual beginning Day 1

Note: Benefits may vary based upon position @type and/or level.

Job Summary

This position provides support for managed care contracts as assigned by the Vice President or System Director. The role involves working with managed care payors and Revenue Cycle Operations to resolve claim payment and administrative issues. The incumbent collaborates with the Vice President of Managed Care, Managed Care Team, Revenue Integrity, and RCO management.

Hybrid position

Essential Functions of the Role

Investigates and resolves reimbursement issues, with the focus being root causes, identified by BSW or payors.

Carries out appropriate managed care related education and training including roll out of new payor contracts.

Assists in payor/plan dispute resolution projects or any other special projects.

Responsible for coordinating payer credentialing & re-credentialing activities.

Works with the RCO to track and reduce managed care denials and underpayments.

Knowledge of Federal and Texas general regulatory environment related to managed care and participates in legislative advocacy activities as appropriate.

Monitor implementation managed care contracts for all BSWH.

Develop payer performance and monitoring tools.

Conduct data analyses and reports for the Vice President or System Director on payments and operational issues related to Managed Care contract language.

Responsible for successful operations between Company and Managed Care Organizations. This includes HMO/PPO/POS, Managed Medicare, Managed Medicaid, and Health Insurance Exchanges.

Coordinates and manages all monthly or quarterly Managed Care Operations meetings with payors. Ensures timely and accurate payment of claims.

Participates with leadership in the Managed Care Department to improve future payer contract terms. Focus areas include revenue enhancement, strategic service-line revenue, and language provisions impacting payment.

Key Success Factors

Managed care experience requires knowledge of managed care concepts, financial analysis, insurance payment systems, legal procedures, IT systems, and current legislation at state and federal levels.

Extensive interpersonal and communication skills to conduct education programs. Effectively interact with internal and external personnel, including physicians, attorneys, management, employers, managed care organizations, and other providers.

Ability to guide and self-manage, adapting easily to changing conditions, work priorities, and work responsibilities.

Dispute resolution and conflict management skills.

Proficient in all Microsoft Products.

Belonging Statement

We believe that all people should feel welcomed, valued and supported.

QUALIFICATIONS

EDUCATION - Bachelor's or 4 years of work experience above the minimum qualification

EXPERIENCE - 5 Years of Experience

As a health care system committed to improving the health of those we serve, we are asking our employees to model the same behaviours that we promote to our patients. As of January 1, 2012, Baylor Scott & White Health no longer hires individuals who use nicotine products. We are an equal opportunity employer committed to ensuring a diverse workforce. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.

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