Managed Care Coordinator
: Job Details :

Job Title & Specialty Area: Managed Care CoordinatorDepartment: Managed CareLocation: Dallas, TXShift: Monday - FridayJob Type: Remote in Texas onlyWhy Children's Health?At Children's Health, our mission is to Make Life Better for Children, and we recognize that their health plays a crucial role in achieving this goal.Through our cutting-edge treatments and affiliation with UT Southwestern, we strive to deliver an extraordinary patient and family experience, ensuring that every moment, big or small, contributes to their overall well-being.Our dedication to promoting children's health extends beyond our organization and encompasses the broader community. Together, we can make a significant difference in the lives of children and contribute to a brighter and healthier future for all.Summary:The Managed Care Coordinator is responsible for the coordination of activities associated with the negotiation and operations of Children's facilities' and professional groups' managed care contracts for both Commercial and Medicaid Managed Care plans. In addition, this position will act as a facility resource to understand the payor and reimbursement relationships that affect our business performance. The Managed Care Coordinator will serve as a designated liaison between Managed Care Organizations (MCOs) and internal personnel and will interact cooperatively with front line and supervisory personnel in various work units. Responsibilities include creating Letters of Agreement, contract implementation support, ongoing maintenance of managed care agreements, and communication and education to staff related to payor updates and operations, on behalf of Children's Medical Center Dallas, Children's Medical Center Plano and other facilities and professional groups.Responsibilities:* Responsible for the creation, negotiation, execution and maintenance of Letters of Agreement (LOAs)/ Single Case Agreement (SCA) with out-of-network MCOs in order to facilitate appropriate admissions in accordance with the quality patient care objectives of the facility and secure revenue.* Manage the department's MCO Email box, acting as a liaison for payor operational issues and as intermediary on resolutions between internal departments and MCOs.* Analyze and identify problems, to determine cause and desired resolution, and engage appropriate Managed Care colleagues for management of issues when applicable.* Take steps to implement resolution on sensitive payor issues by assisting MCOs and internal departments with operationalizing strategies to correct operational deficiencies and improve managed care services.* Solve problems related to his / her area of assignment and maintain detailed knowledge of functions in these areas. When needed, appropriately escalate issues or concerns that require direct input from Managed Care leadership.* Receive, process and notify internal departments of all incoming contracts / amendments. Work collaboratively with MCOs, Contract Manager, and other departments as needed to ensure all new contracts/ amendments are fully executed and filed. Oversee maintenance of Managed Care contract files and support managed care contract review projects, as needed.* Support independent dispute resolution (IDR) program activities, as assigned. This may include notifying insurance providers of intent to dispute claim payment, validating claim details and collecting required documents, negotiating reimbursement rates, managing dispute cases through regulated processes, completing invoice payment requests, scheduling mediations and completing mediations. Present and operationalize solutions for enhanced program management and organization if opportunities are identified.* Serve as designated web administrator / security officer with MCOs to ensure facility personnel are assigned access to MCO provider web portals Delegate departmental web administrators to assist with login / password issues as needed.* Manage the implementation and maintenance of managed care information including the Managed Care shared sites and contract management system. Distribute education in concert with the department's Program Managers and Program Directors to identify specific managed care outcomes. Support reporting activity and statistical information regarding out of network plans, as required by leadership.* Serve as a resource to facility personnel regarding MCO policies and procedures. Distribute MCO provider updates to appropriate internal departments including, but not limited to: Admitting, Financial Counseling, Patient Financial Services (PFS), Denials Prevention (DPD), Health Information Management (HIM), Revenue Integrity (RI), Compliance and Accreditation, Utilization Management (UM), Centralized Authorization Department (CAD), Pharmacy, and other operational and clinical departments as needed.How You'll Be Successful:Other information:WORK EXPERIENCE* At least 3 years Related experience Required* Must possess a full understanding of issues associated with managed care contracting and maintain superior skills in conflict resolution and meeting facilitation along with in-depth working knowledge of office procedures and organizations in a managed care settingEDUCATION* Two-year associate's degree or equivalent experience In Business, Business Administration, Healthcare Administration, Management or other related field with coursework emphasis in the medical or healthcare field; or equivalent combination of education and experience Required* Four-year bachelor's degree or equivalent experience PreferredLICENSES AND CERTIFICATIONS* Certified Healthcare Financial Professional (CHFP) Upon Hire Preferred* Fellow of the Healthcare Financial Management Association (FHFMA) Upon Hire Preferred* Certified Professional Medical Services Management (CPMSM) Upon Hire PreferredA Place Where You BelongWe put our people first. We welcome, value, and respect the beliefs, identities and experiences of our patients and colleagues. We are committed to delivering culturally effective care, creating meaningful partnerships in the communities we serve, and equipping and developing our team members to make Children's Health a place where everyone can contribute.Holistic Benefits - How We'll Care for You:* Employee portion of medical plan premiums are covered after 3 years.* 4%-10% employee savings plan match based on tenure* Paid Parental Leave (up to 12 weeks)* Caregiver Leave* Adoption and surrogacy reimbursementAs an equal opportunity employer, Children's Health does not discriminate against employees or applicants because of race, color, religion, sex, gender identity and expression, sexual orientation, age, national origin, veteran or military status, disability, or genetic information or any other Federal or State legally-protected status or class. This applies to all aspects of the employer-employee relationship including but not limited to recruitment, hiring, promotion, transfer pay, training, discipline, workforce adjustments, termination, employee benefits, and any other employment-related activity.