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Manager of Payment Integrity

Florence, SC
TRACKING CODE

1968

JOB DESCRIPTION
  1. Provides support to the managed care contract negotiation process.
  2. Works with Senior Managed Care Analysts to monitor and report managed care contract financial performance.
  3. Oversees the daily operations of the managed care compliance system including underpayments and denials management, as well as contract management and compliance operations.
  4. Responsible for formal dispute initiatives with managed care payors.
  5. Provide dedicated managed care support to other hospital departments as well as Physician Practices, Home Health, and Hospice.
  6. Participate and coordinate organizational meetings with contract payers.
  7. Coordinate research of employer health plan information.
  8. Provide service/code-specific managed care reimbursement as requested by internal departments.
  9. Participate in other organizational projects as assigned by Director of Managed Care – Corp, Vice-President of Business Operations, or Chief Financial Officer.
  10. Coordinates the timely appeal of all third-party denials and underpayments.

Qualifications /Training:

  • Three years experience in provider-based managed care, patient financial services, or denials management operations.
  • Experience in analyzing managed care reimbursement methodologies.
  • Comprehensive knowledge of managed care terminology.
  • Working knowledge of Patient Financial Services applications.
  • Procedural knowledge of hospital and physician practice accounts receivable management.
  • Ability to analyze business problems and opportunities and provide effective practical solutions while focusing on continuous improvement and innovation
  • Excellent verbal and written communication skills

Licenses/Certifications/Registrations/Education:

  • Bachelors Degree or 3 years management experience within the Revenue Cycle required.
WORK SCHEDULE

Full time

JOB LOCATION

Florence, SC, United States

POSITION TYPE

Full time

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