CHA Hollywood Presbyterian (CHA HPMC) is a nationally recognized acute care facility that has been caring for the Hollywood community and Los Angeles Areas since 1924.
Join our Global Network and be a CHA Global Ambassador
CHA HPMC is also a part of the world-renown CHA Health System (CHS).
CHS has CHA University which consists of 14 education institutions including medical school, nursing school and pharmacy.
CHA global network operates 81 hospitals and specialty clinics, 30 research and 31 bio/pharmaceutical/healthcare companies with 14,000 employees in seven countries.
Our New Facility is seeking for Top Talents
The best women’s hospital in Los Angeles is looking for current RN candidates to staff Operating Room, Emergency Department, Labor & Delivery and Mother-Baby care units to be housed in our expanding new patient tower facility scheduled to open next year.
Come be a part of this dedicated and caring team right in the heart of Hollywood.
Position Summary:
The Managed Care Coordinator serves as the conduit for payer-related questions, concerns and issues within the hospital, its partners and with third-party payers.
This position provides expert assistance with letters of agreement (LOAs) and contracts with providers seeing the hospital’s capitated members.
This position is responsible for organizing, understanding, and managing the hospital’s contracts pertaining to reimbursement.
These responsibilities will be achieved by creating and maintaining a summary of all managed care contracts and associated insurance plans and understanding and interpreting the payer contract language and fee schedules.
This position will oversee contract details and be knowledgeable about major provisions of agreements as they relate to day-to-day operations.
Duties:
1.
Secures Letters of Agreement (LOA).
These LOAs maybe for capitated members going to non-contracted providers or for non-contracted payers to send patients to HPMC.
2.
Serve as a subject matter expert to Business Office addressing questions related to contract payment methodology.
3.
Maintains contracts summaries in hospital’s contract matrix.
This information will include fee schedules, key dates and payment methodologies for the contracts.
4.
Assists with contract negotiations, assist with determining financial impact of negotiations.
5.
Partner with analytics resources at hospital to co-develop financial models to track and monitor receivables in order to respond quickly to negative changes and enhance positive factors.
6.
Performs internal audits to verify contracted rates are paid by health plan and analysis of variance for inpatient and outpatient receivables.
7.
Resolves claim variances by directing workflow for manual intervention to the collections department, personally assisting as needed.
8.
Works and builds relationships with health plans and MSO partners to address and resolve external root causes to issues/variances.
9.
Maintains hospital’s “network” file of contracted providers.
Qualifications:
Minimum Education:
High school diploma required
Preferred Education:
Bachelors degree preferred
Minimum Work Experience and Qualifications:
Strong ability to communicate effectively verbally and in writing.
Previous managed care collection experience in an acute care setting
3-years of relevant payor contract support required
Managed Care contract review and contract language interpretation required
Must be able to work in a union environment.
Preferred Work Experience and Qualifications:
Healthcare experience: 5 years or more
Required Licensure, Certification, Registration or Designation:
Current Los Angeles County Fire Card required (within 30 days of employment
Shift: Days
Hours: 8
Shift Hours: 8:00am-4:30pm
Weekly Hours: 40
Type: Exempt
FTE: 1.
0
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