Managed Care Coordinator - MD Anderson
Houston, TX
About the Job
MISSION STATEMENT
The mission of The University of Texas M. D. Anderson Cancer Center is to eliminate cancer in Texas, the nation, and the world through outstanding programs that integrate patient care, research and prevention, and through education for undergraduate and graduate students, trainees, professionals, employees and the public.
SUMMARY
Responsible for monitoring the operational compliance of single case agreements (SCAs), including commercial, governmental, international, transfer, satellite and spot agreements, which includes, overseeing, preparing and delivering communication, education and guidance needed to support the processes and obligations required per the terms of the managed care agreements. Specifically, the Coordinator will be responsible for the coordination and execution of patient specific SCAs which outline the terms and conditions of reimbursement for care provided to such patients. Builds and maintains working relationships with non-contracted plans and payors to facilitate with timely communication and seamless coordination of care for patients. Serves as a liaison between the non-contracted managed care plans/payors and MD Anderson's clinical and Access teams to provide education. Maintains SCAs in the electronic medical record system and develops/generates reports annually and/or on an ad hoc basic specific to the SCA patient population.
JOB SPECIFIC COMPETENCIES
Management and Support of Single Case Agreements
Works with the applicable plan, payor or outside facility to secure legally approved single case agreements (SCAs) for patients covered under non-contracted managed care plan payor or for inpatients requiring a service not provided by MD Anderson. Annual volume of SCAs is approximately 10K, with year-over-year growth resulting from an aging population and increased use of Medicare Advantage plans. Oversee and facilitate the execution of patient specific SCAs which outline the terms and conditions of reimbursement for care provided to such patients. Partner with contract administrators on adjustments and changes when requested. Oversee and facilitate the execution of patient specific SCAs which outline the terms and conditions of reimbursement for care provided to such patients. Partner with contract administrators on adjustments and changes when requested. Oversee and facilitate the execution of patient specific SCAs which outline the terms and conditions of reimbursement for care provided to such patients. Partner with contract administrators on adjustments and changes when requested.
Required Education:
High school diploma or equivalent.
Preferred Education:
Bachelor's degree in business, healthcare administration or related field.
Five years experience in managed care organization, academic health provider, or public health organization. OR Three years with a Bachelor's degree, experience in managed care organization, academic health provider, or public health organization. May substitute required education with additional years of equivalent experience on a one to one basis.
Preferred Experience/Skills:
Experience in hospital or physician revenue cycle - patient access, financial clearance, claims (billing or follow-up), health insurance, good documentation skills, self starter who can work independently.
Work Schedule:
This position is 100% remote and the shift is 8am-5pm. We are searching for candidates in the Houston, Texas local area only. No out of town, no out of state. Training period will require to work full time onsite.
It is the policy of The University of Texas MD Anderson Cancer Center to provide equal employment opportunity without regard to race, color, religion, age, national origin, sex, gender, sexual orientation, gender identity/expression, disability, protected veteran status, genetic information, or any other basis protected by institutional policy or by federal, state or local laws unless such distinction is required by law. http://www.mdanderson.org/about-us/legal-and-policy/legal-statements/eeo-affirmative-action.html
Additional Information
#LI-Remote
The mission of The University of Texas M. D. Anderson Cancer Center is to eliminate cancer in Texas, the nation, and the world through outstanding programs that integrate patient care, research and prevention, and through education for undergraduate and graduate students, trainees, professionals, employees and the public.
SUMMARY
Responsible for monitoring the operational compliance of single case agreements (SCAs), including commercial, governmental, international, transfer, satellite and spot agreements, which includes, overseeing, preparing and delivering communication, education and guidance needed to support the processes and obligations required per the terms of the managed care agreements. Specifically, the Coordinator will be responsible for the coordination and execution of patient specific SCAs which outline the terms and conditions of reimbursement for care provided to such patients. Builds and maintains working relationships with non-contracted plans and payors to facilitate with timely communication and seamless coordination of care for patients. Serves as a liaison between the non-contracted managed care plans/payors and MD Anderson's clinical and Access teams to provide education. Maintains SCAs in the electronic medical record system and develops/generates reports annually and/or on an ad hoc basic specific to the SCA patient population.
JOB SPECIFIC COMPETENCIES
Management and Support of Single Case Agreements
Works with the applicable plan, payor or outside facility to secure legally approved single case agreements (SCAs) for patients covered under non-contracted managed care plan payor or for inpatients requiring a service not provided by MD Anderson. Annual volume of SCAs is approximately 10K, with year-over-year growth resulting from an aging population and increased use of Medicare Advantage plans. Oversee and facilitate the execution of patient specific SCAs which outline the terms and conditions of reimbursement for care provided to such patients. Partner with contract administrators on adjustments and changes when requested. Oversee and facilitate the execution of patient specific SCAs which outline the terms and conditions of reimbursement for care provided to such patients. Partner with contract administrators on adjustments and changes when requested. Oversee and facilitate the execution of patient specific SCAs which outline the terms and conditions of reimbursement for care provided to such patients. Partner with contract administrators on adjustments and changes when requested.
Required Education:
High school diploma or equivalent.
Preferred Education:
Bachelor's degree in business, healthcare administration or related field.
Five years experience in managed care organization, academic health provider, or public health organization. OR Three years with a Bachelor's degree, experience in managed care organization, academic health provider, or public health organization. May substitute required education with additional years of equivalent experience on a one to one basis.
Preferred Experience/Skills:
Experience in hospital or physician revenue cycle - patient access, financial clearance, claims (billing or follow-up), health insurance, good documentation skills, self starter who can work independently.
Work Schedule:
This position is 100% remote and the shift is 8am-5pm. We are searching for candidates in the Houston, Texas local area only. No out of town, no out of state. Training period will require to work full time onsite.
It is the policy of The University of Texas MD Anderson Cancer Center to provide equal employment opportunity without regard to race, color, religion, age, national origin, sex, gender, sexual orientation, gender identity/expression, disability, protected veteran status, genetic information, or any other basis protected by institutional policy or by federal, state or local laws unless such distinction is required by law. http://www.mdanderson.org/about-us/legal-and-policy/legal-statements/eeo-affirmative-action.html
Additional Information
- Requisition ID: 171080
- Employment Status: Full-Time
- Employee Status: Regular
- Work Week: Days
- Minimum Salary: US Dollar (USD) 51,000
- Midpoint Salary: US Dollar (USD) 64,000
- Maximum Salary : US Dollar (USD) 77,000
- FLSA: exempt and not eligible for overtime pay
- Fund Type: Hard
- Work Location: Remote (within Texas only)
- Pivotal Position: No
- Referral Bonus Available?: No
- Relocation Assistance Available?: No
- Science Jobs: No
#LI-Remote
Source : MD Anderson
