• Job Description

  Req#: 217026
  Become part of an inclusive organization with over 40,000 teammates, whose mission is to improve the health and well-being of the unique communities we serve.
  
  Summary:
  The Managed Care Specialist optimizes managed care reimbursement by providing analysis and support during contracting process. Supplies reimbursement reports and analyses. Ensures optimization of net revenue under existing managed care contracts and acts as consultant on managed care issues
  
  Responsibilities:
  1. Single Case Agreements- Manages process for obtaining physician Single Case Agreements (SCAs) with non-contracted payers, for physicians associated with UNC Health Care System. Negotiates agreements within established policies, facilitates execution, and monitors accounts to ensure processing occurs within negotiated terms.
  2. Payments- Provides reconciliation, direction and training regarding payments. Audit and review, particularly large and complex cases, to ensure that they are adjudicated per the terms of the appropriate payer agreement. Often requires direction and training for staff currently handling these cases.
  3. Managed Care Analysis- Uses data systems to provide frequent and varied ad hoc reporting to Contract Manager and others, and assists in analyzing data for various contractual relationships. Reviews, resolves and evaluates low pay situations. Identifies trends and pursues resolution.
  4. Managed Care Audits- Takes independent role in auditing the reimbursement for services provided annually. Works very closely with payers to resolve discrepancies and delinquencies.
  
  Other Information
  
  Other information:
  Education Requirements:
  • Bachelor's degree in relevant field
  Licensure/Certification Requirements:
  • No licensure or certification required.
  Professional Experience Requirements:
  • If a Bachelor's degree, requires no additional years of experience If Associate's degree, requires four (4) years of experience with managed care contracts, data analysis or provider relations. If High School diploma or GED, requires eight (8) years of experience with managed care contracts, data analysis or provider relations.
  Knowledge/Skills/and Abilities Requirements:
  
  Job Details
  
  Legal Employer: NCHEALTH
  
  Entity: Shared Services
  
  Organization Unit: Managed Care
  
  Work Type: Full Time
  
  Standard Hours Per Week: 40.00
  
  Salary Range: $23.24 - $33.41 per hour (Hiring Range)
  
  Pay offers are determined by experience and internal equity
  
  Work Assignment Type: Remote
  
  Work Schedule: Day Job
  
  Location of Job: US:NC:Morrisville
  
  Exempt From Overtime: Exempt: Yes
  
  This position is employed by NC Health (Rex Healthcare, Inc., d/b/a NC Health), a private, fully-owned subsidiary of UNC Health Care System, in a department that provides shared services to operations across UNC Health Care; except that, if you are currently a UNCHCS State employee already working in a designated shared services department, you may remain a UNCHCS State employee if selected for this job.
  
  Qualified applicants will be considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, status as a protected veteran or political affiliation.
  
  UNC Health makes reasonable accommodations for applicants' and employees' religious practices and beliefs, as well as applicants and employees with disabilities. All interested applicants are invited to apply for career opportunities. Please email applicant.accommodations@unchealth.unc.edu if you need a reasonable accommodation to search and/or to apply for a career opportunity.

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