Shire Jobs

Description

A Hospital in Van Nuys is looking for a Managed Care Coordinator to work in its Managed Care Department. The right person for this role must have 5+ years of experience with managed care in a hospital setting.

Duties:

• Responsible for negotiating ancillary and health plan agreements on behalf of the hospital

• Negotiates and processes one-time agreements (MOUs, LOAs, etc.) for our network cases

• Direct knowledge and experience with State and Federal laws and regulations pertinent to healthcare including HIPAA, Department of Managed Health Care (DMHC), Department of Health Care Services (DHCS), CMS, etc

• Strong leadership and negotiation skills

• Knowledge of managed care contracting rates for network providers, services, and facilities

• Ability to operate well under high-stress conditions and be extremely organized, paying high attention to detail

• Ability to read, analyze and interpret common industry related journals, financial reports and legal documents

• Ability to respond to common inquiries or complaints from customers, regulatory agencies, or members of the business community

• Advanced ability to operate computers and related software for Microsoft programs including Word, Excel, Outlook and accounting software

• Ability to write reports and business correspondence and effectively present information to top management, clients, external groups and/or boards of directors

• Track and trend CAP member performance collaborating with Management Service Organization

• Participate in JOC meetings

• Contract modelling

• Advanced ability to operate computers and related software for Microsoft programs including Word, Excel, Outlook and accounting software

• Review and prepare documentation for CAP potential legal cases

Requirements • Proficiency in using EHR (Electronic Health Records) SYSTEM is essential.

• Must possess the ability to handle Appeals effectively.

• Experience in Negotiating Contracts within the healthcare sector is required.

• Should have a proven track record in Manage Care Contracting.

• Ability to Manage Care Contracts is mandatory.

• Experience in Medicaid Manage Care is preferred.

• Should be able to develop and Manage Care Plans effectively.

• Familiarity with the Manage Care Industry and its dynamics is necessary.

• Experience in Medical Billing is an added advantage.

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