Director, Managed Care

How you move is why we're here.

Now more than ever.

Get back to what you need and love to do.

The possibilities are endless...

Now more than ever, our guiding principles are helping us in our search for exceptional talent - candidates who align with our unique workplace culture and who want to maximize the abundant opportunities for growth and success.

If this describes you then let's talk!

HSS is consistently among the top-ranked hospitals for orthopedics and rheumatology by U.S. News & World Report. As a recipient of the Magnet Award for Nursing Excellence, HSS was the first hospital in New York City to receive the distinguished designation. Whether you are early in your career or an expert in your field, you will find HSS an innovative, supportive and inclusive environment.

Working with colleagues who love what they do and are deeply committed to our Mission, you too can be part of our transformation across the enterprise.

Emp Status

Regular Full time

Work Shift

Compensation Range

The base pay scale for this position is $112,000.00 - $170,875.00. In addition, this position will be eligible for additional benefits consistent with the role. The salary of the finalist selected for this role will be determined based on various factors, including but not limited to: scope of role, level of experience, education, accomplishments, internal equity, budget, and subject to Fair Market Value evaluation. The hiring range listed is a good faith determination of potential compensation at the time of this job advertisement and may be modified in the future.

What you will be doing

JOB DESCRIPTION

Managed Care Manager job description

Reporting to the Director of Payer Relations, the Managed Care Manager will play a critical support role in facilitating engagement between Insurance Payers, Revenue Cycle, internal and external billing departments, and various other stakeholders. This position will have particular focus in triaging systemic claims issues to assess the full scope and impact while identifying root cause allowing for successful escalation and resolution. The Managed Care Manager will rely on interpretation of both Payer contracts and polices, along with an understanding of Accounts Receivable, to ensure that issues presented by Revenue Cycle are addressed and resolved in a timely manner.

RESPONSIBILITIES:

• Maintain knowledge of Managed Care contracts and Payers' payment rules and policies.
• Work closely with other members of the Managed Care team, Revenue Cycle, and/or professional billing entities to size and resolve identified Payer issues impacting Accounts Receivable and contract performance for both PHO providers and facilities.
• Responsible for ensuring reports and updates (i.e., A/R denials, project status, etc.) are disseminated to departmental staff.
• Escalate issues as necessary to Payer contacts for resolution with engagement and input from the Managed Care contracting team as needed. Recommend escalation as appropriate to senior management.
• Additional responsibilities as required to accomplish departmental goals.

EXPERIENCE, COMPETENCIES, AND PERSONAL CHARACTERISTICS:

• Experience (minimum 3+ years) with Payer or provider contracting and/or Revenue Cycle management.
• Experience with EPIC or other comparable EMR systems preferred.
• Possesses knowledge of Payer policies and resolution processes.
• Knowledge of the healthcare industry and Payer reimbursement methodologies (both hospital and physician).
• Ability to work independently and collaboratively to solve complex problems.
• Excellent verbal and written communication skills.
• Excellent organizational and multi-tasking skills.

EDUCATION:

• Bachelor's degree in health or business administration, economics or related subject is required. Masters preferred.

Non-Discrimination Policy

Hospital for Special Surgery is committed to providing high quality care and skilled, compassionate, reliable service to our community in a safe and healing environment. Consistent with this commitment, Hospital for Special Surgery provides care, admits, and treats patients and provides all services without regard to age, race, color, creed, ethnicity, religion, national origin, culture, language, physical or mental disability, socioeconomic status, veteran or military status, marital status, sex, sexual orientation, gender identity or expression, or any other basis prohibited by federal, state, or local law or by accreditation standards.