Managed Care Operations Manager Worcester, MA
Job description
Responsible for managed care operations activities for UMass Memorial Medical Center and UMass Memorial Medical Group (collectively “UMMHC”). Acts as primary liaison with managed care plans relative to the research and resolution of claims payment discrepancies.
Major Responsibilities:
- Responsible for resolution of operational issues impacting claims payment, including billing, patient registration, referral and authorization, credentialing, and provider set up issues. Works with internal and external customers to improve workflow and resolve payment discrepancies.
- Researches UMMHC contractual requirements and operational policies to ensure health plan compliance with negotiated financial arrangements. Coordinates efforts with management within Contracting and Provider Relations.
- Provides effective direction, guidance, and leadership in conducting monthly claims meetings and fosters effective teamwork in problem resolution.
- Coordinates the assignment of tasks and helps resolve technical and operational problems. Evaluates the impact of solutions to ensure goals are achieved.
- Participates in performance improvement initiatives and demonstrates the use of quality improvement in daily operations.
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Position Qualifications:
Bachelor’s degree or equivalent in Business Administration, Health Care Management or related discipline. Minimum of 5-7 years experience in a managed care setting, with a thorough understanding of managed care plan operations, is required. A thorough understanding of clinical operations, hospital and physician billing and health care terminology, and managed care policy required. Excellent verbal and written communication skills. Former managerial experience is preferred.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.
