This is a hybrid role based out the Paca Pratt building downtown Baltimore.
General Summary
Responsible for providing support to Payer operations with UMMS contracted commercial, Medicare Advantage and Medicaid MCO Payers. Track and report on Payer policy changes and monitor and facilitate the resolution of administrative and clinical operational and payment issues. Serve as a resource for the Revenue Cycle Central Business Offices on the terms and requirements of Payer contracts. Work is performed under limited supervision. Direct report to the Manager, Payer Relations.
Job Description
Principal Responsibilities and Tasks
The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. These statements are not to be construed as an exhaustive list of all job duties performed by personnel so classified.
- Maintain amicable and professional relations with Payer Representatives.
- Actively monitor payer policy updates and assess their implications to the organization (administrative and clinical) and disseminate to the appropriate UMMS department.
- Support revenue cycle operations, hospitals, and professional entities, by facilitating resolution to escalated issues through Payer Representatives.
- Collaborate with clinical, administrative, and Revenue Cycle functional areas to identify opportunities for operational improvements.
- Establish and maintain relations with internal clinical stakeholders to resolve Payer issues that involve clinical operations.
- Support UMMS patient access teams, hospitals, and professional entities to ensure that these areas have an avenue to escalate issues that affect patient care.
- Independently facilitate, coordinate, and conduct Payer education and training for administrative and clinical team members on programs, processes, and policies.
- Serve as point of contact for internal stakeholders and Payers for inquiries associated with policies and procedures, including escalated issues.
- Plan, organize, and conduct professional and hospital Joint Operating Committee Meetings for all contracted Payers.
- Perform other duties as assigned.
Education and Experience
- Associate’s degree in healthcare administration, Accounting, Finance, or related field. Bachelor’s degree preferred.
- Minimum three (3) years’ experience in health insurance, managed care, or healthcare administration.
- Minimum three (3) years’ experience in healthcare reimbursement methodologies required
- Minimum three (3) years’ experience with Commercial (HMO, PPO, POS), Medicare (including Medicare Advantage) Medicaid (including Managed Care Plans) Health Plans.
- Experience using an electronic EMR (e.g., EPIC) preferred.
- AAHAM, NAHAM, HFMA, AAPC, and/or AHIMA certification preferred.
Knowledge, Skills and Abilities
- Working knowledge of Payer contract clauses applicable to payments and administrative terms.
- Advanced knowledge and understanding of claims processing systems and guidelines including ICD10/CPT Coding and medical terminology.
- Working knowledge of healthcare issues to effectively interact with administration, hospital, and physician/ancillary practice personnel.
- Strong listening, presentation, and facilitation skills.
- Ability to analyze, compare, contrast, and validate work with keen attention to detail.
- Effective skill managing multiple staff initiatives and priorities to accomplish objectives.
- Effective skill developing and maintaining collaborative working relationships with all levels of leadership, staff and vendors.
- Effective analytical, conceptual thinking, planning, organizational, and problem-solving skills.
- Ability to work independently and as part of a team in a fast-paced, dynamic environment.
- Effective skill in the use of Microsoft Office Suite (e.g., Access, Word, Excel, PowerPoint).
- Advanced verbal, written and interpersonal communication skills.
Additional Information
All your information will be kept confidential according to EEO guidelines.
