This position is responsible for working directly with managed care payers and PFS to resolve claim payment and administrative issues occurring with managed care contracts. The incumbent will work collaboratively with Vice President Managed Care, Managed Care Team, Revenue Integrity, and PFS management to identify and implement best practices for the recovery of patient accounts, improve information systems infrastructure, and share knowledge to enhance the recovery process.
Participates in developing the strategic course for acute care hospitals and ancillary care providers in accordance with Company's and Region's overall guidance in such areas as delivery system redesign, healthcare reform and strategic pricing and recovery approaches; and
Responsible for successful operations between Company and Managed Care Organizations, including but not limited to HMO/PPO/POS, Managed Medicare, Managed Medicaid, and Public and Private Health Insurance Exchanges.
Maintain effective and productive working relationships with payer representatives at Managed Care Organizations
Ensures that all required payer processes are understood and adhered to by Company providers (e.g. eligibility, authorization compliance, etc.) to (a) maximize contract performance/yield (e.g. Net Revenue per adjusted admission and per day, contribution margin, etc. (b) maintain consistency with contracting requirements established by VP Managed Care.
Maintain current knowledge, analyze and evaluate billing and collection trends of Managed Care Organizations (e.g zero balance, zero pay) and educate hospital personnel on manage care requirements to ensure expected revenue is within acceptable levels.
Coordinates and manages all monthly and/or quarterly Managed Care Operations meetings with payers to ensure timely and accurate payment of claims.
Participates with leadership in Managed Care Department to improve future payer contract terms in areas such as revenue enhancement, strategic service-line revenue, language provisions impacting payment.
Ensures that a permanent record of all payer meetings and follow-up documentation (internal and external to Company) relating to operational improvement activities are maintained at all times to allow constant and consistent improvement and communication with payers.
Act as a managed care resource to all regions within the organization
Facilitate managed care education to internal/external customers
Performing other management related tasks as needed
Follows the CHRISTUS guidelines related to the Health Insurance Portability and Accountability Act (HIPAA), designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI).
Maintains strict confidentiality.
Uses oral and written communication skills to effectively convey ideas in a clear, positive manner that is consistent with the CHRISTUS Mission.
Maintains established CHRISTUS policies, procedures, objectives, quality assurance, safety, environmental and infection control.
Implements job responsibilities in a manner that is consistent with the CHRISTUS Mission and Code of Ethics and supportive of CHRISTUS's cultural diversity objectives.
Our Mission: WHY WE EXIST. To extend the healing ministry of Jesus Christ. Our Core Values: WHAT WE BELIEVE IN.DIGNITY Respect for the worth of every person, recognition and commitment to the value of diverse individuals and perspectives, and special concern for the poor and underserved. INTEGRITY Honesty, justice, and consistency in all relationships. EXCELLENCE High standards of service and per...formance. COMPASSION Service in a spirit of empathy, love, and concern. STEWARDSHIP Wise and just use of talents and resources in a collaborative manner.Our Vision: WHAT WE ARE STRIVING TO DO. CHRISTUS HEALTH, a Catholic health ministry, will be a leader, a partner and an advocate in the creation of innovative health and wellness solutions that improve the lives of individuals and communities so that all may experience God's healing presence and love. Our Name and Symbol:WHO WE ARE. CHRISTUS is Latin for "Christ," and proclaims publicly the core of our mission. OUR NAME choice also recognizes the heritage of our two congregational sponsors, the Sisters of Charity of the Incarnate Word in Houston and San Antonio. Jesus Christ is the Incarnate Word, the Word of God made flesh. It is, therefore, only fitting that it is in another form of His name that our health ministries are called together. OUR SYMBOL Reflects the healing ministry of Jesus Christ - a combination of a medical cross and a religious cross. The flowing banner on the cross is a common symbol of the risen Christ, while the royal purple signifies Christ. The flowing banner also conveys a sense of motion as we move forward into a new era of service to our communities.