Senior System Consultant - Managed Care
Category: Professional/Technical
Facility: Genesis Healthcare System
Department: Financial and Reimbursement Services
Schedule: Full Time
Shift: Day Shift
Hours: 80 bi-weekly / 8am-4:30pm
Contact Information: Contact: Human Resources
Job Details:

JOB SUMMARY

Maintains accurate managed care modeling and payment variance information systems.  Verifies reporting from such systems in order to provide accurate, high quality information pertaining to contract management outcomes as needed for financial analysis and recovery of payment variances from third party payors.

 

ESSENTIAL DUTIES

1.     Designs, tests and activates the contract management information systems, including Epic and any other contract management system.

2.     Resolves Epic expected reimbursement system functionality issues via assigned Footprints tickets.

3.     Manages assigned Work Queues within Epic by performing the necessary investigation and analysis to determine reasons for payment variances of third party claims.

4.     Contacts third-party payers regarding incorrectly paid claims.

5.     Actively works to prevent payment variances including providing training and support to Genesis HealthCare System departments.

6.     Logs, tracks and resolves payment issues resulting in additional reimbursement or clarification of the issue including denied claims.

7.     Acts as the gatekeeper for new payor/plan build and design within Epic.

8.     Supports all hospital departments with reimbursement methodology, contract language knowledge, and proper identification of third-party payers during registration.

9.     Develops and maintains documentation and procedures, as needed, to provide training to other staff.

10.   Negotiates individual non-network cases with mental health providers and others.

11.   Develops and maintains models and documentation of contract management system requirements and configures systems accordingly.

12.   Maintains documentation of current system programming and table changes.

13.   Assists with preparation of testing of all contract management systems to ensure proper system configuration.

14.   Logs, tracks, analyzes, and coordinates contract management system changes including any vendor software update implementations.

15.   Works with all contract management system vendors to resolve issues/problems in a timely manner.

16.   Tracks information and completes detailed analyses reports.

17.   Maintains file on problem EOB’s for periodic review and follow-up.

18.   Effectively utilizes project tools, technologies and methodologies to provide clear and concise documentation/communication (i.e. project tracking, weekly reports, etc.).

19.   Maintains open communications with functional area manager/director regarding projects and systems issues.

20.   Prioritizes and schedules projects and resources.

 

QUALIFICATIONS

1.     Bachelor’s degree in Accounting, Business Administration, Finance, HealthCare Administration or equivalent experience with reimbursement methodologies, contract language, and adjudication of claims required.

2.     Ability to read and/or write in order to understand, explain, or describe moderately complex information.

3.     Strong verbal and written communication skills, problem solving and critical thinking skills.

4.     Ability to independently prioritize and focus on multiple tasks concurrently.

5.     Ability to develop collaborative relationships and work with a variety of professional external and internal individuals and departments.

6.     Strong PC skills in Word, Excel, Lotus Notes, and Windows applications.

7.     Ability to independently prioritize and focus on multiple tasks concurrently.

 

WORKING CONDITIONS/PHYSICAL REQUIREMENTS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 

1.     Ability to read, categorizes, comprehend and calculate information.

2.     Ability to operate a personal computer for 4 to 8 hours per day.

3.     Ability to read print of various sizes.

4.     Ability to work with detail and accuracy for prolonged periods.

5.     Ability to utilize standard office equipment.

6.     Ability to do some light lifting, stooping, and bending with occasional prolonged standing and walking.

7.     Occasional prolonged standing and walking.

 

This description reflects in general terms the type and level of work performed.  It is not intended to be all-inclusive, nor portray the specific duties of any one incumbent.




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