This position is responsible for managing daily activities related to providing operational support for Payor Enrollment. The candidate will be responsible for working directly with Managed Care Organizations (MCO) to resolve enrollment and administrative escalations occurring with MCO contracts. Responsible for the mentoring and training of team members as needed, providing subject matter expertise to improve efficiencies and results.
Working Manager positon responsible for performing MCO contracting activities
Supervises Payor Enrollment associates
Maintains appropriate MCO documentation as required by MCOs
Assists the "point person" to the hospital leadership teams and business offices for the assigned CHRISTUS region(s) for Payor Enrollment
Investigates and resolves Payor Enrollment issues; creating Processes for opportunities for improvement
Assists in Payor/plan dispute resolution projects or any other special projects
Responsible for coordinating payer credentialing & re-credentialing activities
Knowledge of Federal and Texas general regulatory environment related to managed care and participates in legislative advocacy activities as appropriate
Monitors Payor Enrollment for all CHRISTUS Health Providers
Develops payer performance and monitoring tools
Conducts data analyses/reports to the assigned System Director or Director on payments and operational issues associated with Managed Care contract language.
Responsible for successful operations between Company and Managed Care Organizations, including but not limited to HMO/PPO/POS, Managed Medicare, Managed Medicaid, and Public and Private Health Insurance Exchanges
Coordinates and manages all monthly and/or quarterly meetings with Payors to ensure timeliness of enrollment
POSITION QUALIFICATIONS A. Education/Skills
Bachelor's Degree and/or (3) years' health care experience
OR (6) years health care experience, including (3) years in a health care setting and/or payor organization with experience in contracting, claims resolution, relationship development and staff education with a managed care company or acute care hospital.
Leadership skills to implement initiatives and work across the company to resolve issues
Ability to develop and maintain strong relationships with providers
Meets deadlines and works well under pressure
Strong verbal and written communication skills to interact with all levels of corporate personnel and providers
PC proficiency to include Microsoft Office
Solid understanding of managed care practices/principles, payer reimbursement methodologies (e.g. DRG, Per Diem, Case Rate, etc.) and managed care processes (e.g. authorizations, medical necessity, etc.) as differentiated by market segment
Excellent organizational, communication and multitasking skills
Minimum 3 year working with CAQH, Pecos and other enrollment systems ensuring record keeping and/or management is accurate and timely
CHRISTUS HEALTH is an international Catholic, faith-based, not-for-profit health system comprised of almost more than 600 services and facilities, including more than 60 hospitals and long-term care facilities, 350 clinics and outpatient centers, and dozens of other health ministries and ventures. CHRISTUS operates in 6 U.S. states, Colombia, Chile and 6 states in Mexico. To support our health care ministry, CHRISTUS Health employs approximately 45,000 Associates and has more than 15,000 physicians on medical staffs who provide care and support for patients. CHRISTUS Health is listed among the top ten largest Catholic health systems in the United States.