Department:
Status:
Benefits Eligible:
Hours Per Week:
Schedule Details/Additional Information:
n/a
Pay Range
$28.05 - $42.10Major Responsibilities:- Analyzes and audits Managed Care reimbursements of designated contracts to ensure payor's compliance with payment terms.
- Utilizes third party software to identify and pursue payment discrepancies. Monitors claims payment experience to identify revenue opportunities. Documents and reports ongoing payment/rate compliance with financial contractual obligations.
- Analyzes trends in data to develop excel spreadsheets for payment anomalies. Submits payment recoveries to payers or regulatory agencies for determinations and resolution.
- Identifies discrepancies and contract compliance issues and resolves the problems working in conjunction with payers, providers, and Aurora departments.
- Serves as a liaison, and effectively communicates with providers, physicians, payors, consultants, agents, and Aurora departments. Ensures that all parties are meeting contractual obligations with respect to operation activities and facilitates positive relations, problem solving and service improvements.
- Develops and publishes all communication on assigned contracts, system wide email communications, reference tools, product and rate summaries, prior authorization requirements and other contract operational documents.
- Monitors contract change dates, necessary amendments obtain and validate rate increases, fee schedules, and reimbursement methodologies.
- Works in partnership with management to improve contract claim processing through identified errors and process improvement activities, recommend potential contractual amendments.
- Monitors and identifies training needs with in patient financial services and patient registration. Effectively educates and trains staff on managed care principles, contract requirements and administration procedures (referrals, pre-authorizations, etc.) to maximize revenue. Identifies and suggests operational process improvement initiatives that may result in further meeting contractual obligations.
- Acts as the key resource for internal customers throughout the Aurora Health Care system; business office, revenue cycle, clinics, hospitals, ancillaries, medical management on all contract aspects and compliance questions.
Licensure, Registration, and/or Certification Required:
- None Required.
Education Required:
- Bachelor's Degree in Health Care Administration or related field.
Experience Required:
- Typically requires 3 years of experience in managed care contracting, or insurance networks within a health care environment.
Knowledge, Skills & Abilities Required:
- Strong working knowledge of managed care contracting, contracting language, insurance networks, and reimbursement methodologies.
- Intermediate level proficiency in the use of Microsoft Office (Excel, Word and Access) or similar products.
- Excellent analytical, organizational, and problem solving skills.
- Must have excellent verbal and written communication skills to effectively work with payers. Ability to articulate complex claims issues and interacts with various levels within the organization to obtain desired results.
Physical Requirements and Working Conditions:
- Must operate all equipment essentials in performing the job.
- This position may require some travel so will be exposed to weather and road conditions.
- Generally exposed to a normal office environment.
This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.
Our Commitment to You:
Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including:
Compensation
- Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
- Premium pay such as shift, on call, and more based on a teammate's job
- Incentive pay for select positions
- Opportunity for annual increases based on performance
Benefits and more
- Paid Time Off programs
- Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
- Flexible Spending Accounts for eligible health care and dependent care expenses
- Family benefits such as adoption assistance and paid parental leave
- Defined contribution retirement plans with employer match and other financial wellness programs
- Educational Assistance Program
About Advocate Health
Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.
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What We Do
Advocate Aurora Health is the 11th largest not-for-profit, integrated health system in the United States. As a leading employer in the Midwest, Advocate Aurora Health employs more than 75,000 individuals including more than 22,000 nurses. Advocate Aurora is engaged in hundreds of clinical trials and research studies, and is nationally recognized for its expertise in cardiology, neurosciences, oncology and pediatrics. The organization contributed nearly $2.2 billion in charitable care and services to its communities in 2019.
