Purpose & Scope:
The Managed Care Operations Administrator is a day to day liaison between the hospital and the health plans with which the hospital contracts. Develop and maintain relationships with health plan liaison personnel (provider relations representatives). Gathers information from health plan liaison, websites, newsletters and other publications regarding health plan policies and procedures that impact the hospital’s provision of services and reimbursement. Maintains and updates reference materials that is provided to all appropriate employees periodically. Ensures that all appropriate operations staffs have access to and train on health plan on-line systems. This position provides focused training to departments on managed care contracts and health plan policies and procedures to improve compliance. This position also develops materials and does training on EPIC payers and plans to improve accuracy of registrations. The purpose of this position is to provide a focused resources to work on day to day operational issues and focus on training and process improvement. Assists the Managed Care Operations Director in all of his/her duties.
Education:
Bachelor's degree in healthcare management or in a related field is required.
Master's degree in healthcare administration, business, or equivalent experience is preferred.
Experience:
Five years of provider or payor healthcare experience required.
Certification/Licensure:
None.