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Managed Care Reimbursement Manager

Weill Medical College of Cornell University

New York, NY
Job Code:
Weill Medical College of Cornell University
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Job Details

Job Title Managed Care Reimbursement Manager

JobID 3222

Location: New York, NY

Description Position Summary
Responsible for the management of activities necessary to analyze, monitor, appeal and report on payer reimbursement obligations of group managed care contracts.
Job Responsibilities
+ Manages processes to monitor, identify and track managed care contract payment compliance and payment recovery.

+ Manages the underpayment appeal process. Manages multiple large.scale claim projects on group contracted managed care claims.

+ Designs and maintains claims review model including staying current with all plan payment policies, developing test scenarios and applying filters to claims projects to maintain quality of claims file submission for recovery on payment.

+ Conducts regular meetings with managed care plans to resolve payment discrepancies and secure revenue recovery including identification of trends, systems errors and incorrect interpretation of contract terms.

+ Makes recommendations on claims reprocessing and settlements.

+ Identifies problems and trends that impact reimbursement. Presents action plans to leadership.

+ Develops, trains and supervises analysts in the collection, analysis and audit of contracted managed care claims. Hires, fires, evaluate performance, and conducts appraisal reviews.

+ Creates and maintains reimbursement and provider reports as required to manage contracts.Creates and maintains reimbursement and provider reports as required to manage contracts.

+ Assists senior billing staff from clinical departments and central business office in resolving complex reimbursement issues.

+ Performs other related duties as assigned.
+ Bachelor's Degree in related field
Approximately 5 years of experience in a managed care setting with demonstrated knowledge of insurance operation, professional reimbursement, and billing.
Supervisory level experience at academic medical center preferred.
Knowledge of regional and national managed care contracting requirements, principles and terms highly desired.
Knowledge, Skills and Abilities
+ Demonstrated organizational skills and ability to pay close attention to detail.

+ Demonstrated strong communication and interpersonal skills; demonstrated ability to interact with multiple constituencies and exercise "people skills".

+ Demonstrated ability to manage multiple projects and overlapping deadlines, for individual work and delegated teams.

+ Advanced problem solving and analytical skills.

+ Demonstrated proficiency with MS Office Suite and database applications.

+ Ability to meet deadlines and work in high volume work environment.
Licenses and Certifications
Working Conditions/Physical Demands
Standard office work
Weill Cornell Medicine is a comprehensive academic medical center that's committed to excellence in patient care, scientific discovery, and the education of future physicians in New York City and around the world. Our doctors and scientists.faculty from Weill Cornell Medical College, Weill Cornell Graduate School of Medical Sciences, and the Weill Cornell Physician Organization.are engaged in world.class clinical care and cutting.edge research that connect patients to the latest treatment innovations and prevention strategies. Located in the heart of the Upper East Side's scientific corridor, Weill Cornell Medicine's powerful network of collaborators extends to its parent university Cornell University; to Qatar, where an international campus offers a U.S. medical degree; and to programs in Tanzania, Haiti, Brazil, Austria and Turkey. Our medical practices serve communities throughout New York City, and our faculty provide comprehensive care at NewYork.Presbyterian Hospital/Weill Cornell Medical Center, NewYork.Presbyterian/Lower Manhattan Hospital, and NewYork.Presbyterian/Queens. At Weill Cornell Medicine, we work together to treat each individual, not just their conditions or illnesses, as we strive to deliver the finest possible care for our patients . the center of everything we do. Weill Cornell Medicine is an Equal Employment Opportunity/Minorities/Females/Vet/Disabled employer.

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