Cheyenne, Wyoming
Dallas, Texas
Gainesville, Georgia
Gainesville, Georgia
Durham, North Carolina
Santa Fe, New Mexico
Santa Fe, New Mexico
Durham, North Carolina
Posted: 09-May-26
Location: Morrisville, North Carolina
Categories:
Internal Number: 9999-INFOR-217026
Description
Become part of an inclusive organization with over 40,000 teammates, whose mission is to improve the health and well-being of the unique communities we serve.
Summary:
The Managed Care Specialist optimizes managed care reimbursement by providing analysis and support during contracting process. Supplies reimbursement reports and analyses. Ensures optimization of net revenue under existing managed care contracts and acts as consultant on managed care issues
Responsibilities:
1. Single Case Agreements- Manages process for obtaining physician Single Case Agreements (SCAs) with non-contracted payers, for physicians associated with UNC Health Care System. Negotiates agreements within established policies, facilitates execution, and monitors accounts to ensure processing occurs within negotiated terms.
2. Payments- Provides reconciliation, direction and training regarding payments. Audit and review, particularly large and complex cases, to ensure that they are adjudicated per the terms of the appropriate payer agreement. Often requires direction and training for staff currently handling these cases.
3. Managed Care Analysis- Uses data systems to provide frequent and varied ad hoc reporting to Contract Manager and others, and assists in analyzing data for various contractual relationships. Reviews, resolves and evaluates low pay situations. Identifies trends and pursues resolution.
4. Managed Care Audits- Takes independent role in auditing the reimbursement for services provided annually. Works very closely with payers to resolve discrepancies and delinquencies.
Other Information
Other information:
Education Requirements:
? Bachelor?s degree in relevant field
Licensure/Certification Requirements:
? No licensure or certification required.
Professional Experience Requirements:
? If a Bachelor's degree, requires no additional years of experience If Associate?s degree, requires four (4) years of experience with managed care contracts, data analysis or provider relations. If High School diploma or GED, requires eight (8) years of experience with managed care contracts, data analysis or provider relations.
Knowledge/Skills/and Abilities Requirements:
Job Details
Legal Employer: NCHEALTH
Entity: Shared Services
Organization Unit: Managed Care
Work Type: Full Time
Standard Hours Per Week: 40.00
Salary Range: $23.24 - $33.41 per hour (Hiring Range)
Pay offers are determined by experience and internal equity
Work Assignment Type: Remote
Work Schedule: Day Job
Location of Job: US:NC:Morrisville
Exempt From Overtime: Exempt: Yes
This position is employed by NC Health (Rex Healthcare, Inc., d/b/a NC Health), a private, fully-owned subsidiary of UNC Health Care System, in a department that provides shared services to operations across UNC Health Care; except that, if you are currently a UNCHCS State employee already working in a designated shared services department, you may remain a UNCHCS State employee if selected for this job.
Qualified applicants will be considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, status as a protected veteran or political affiliation.
UNC Health makes reasonable accommodations for applicants' and employees' religious practices and beliefs, as well as applicants and employees with disabilities. All interested applicants are invited to apply for career opportunities. Please email applicant.accommodations@unchealth.unc.edu if you need a reasonable accommodation to search and/or to apply for a career opportunity.
