Payer Relations and Contracting Claim Team Lead / UMMS
Facility: University of Maryland Medical System
Employment Type: Full Time
Location: Baltimore, MD Shift/Schedule: DAY
Department: CRP: MC CONTRACT MGMT
Posted FTE: 1
Job Posting Category: Professionals
Hours of Work: 8 AM - 4:30 PM
Job ID #: 41178
Benefits Eligible: Yes
Minimum Education: Bachelor’s Degree in Allied Health or related area
License/Cert Required: Not Indicated
Minimum Experience: 5 years relevant prof exp in Managed Care /
Specialty Type: Not Applicable
What You Will Do:
The University of Maryland Medical System is a 12-hospital system with academic, community and specialty medical services reaching every part of Maryland and beyond. UMMS is a national and regional referral center for trauma, cancer care, Neurocare, cardiac care, womens and childrens health and physical rehabilitation. UMMS is the fourth largest private employer in the Baltimore metropolitan area and one of the top 20 employers in the state of Maryland. No organization will give you the clinical variety, the support, or the opportunities for professional growth that you’ll enjoy as a member of our team. UMMS is currently seeking a Payer Relations and Contracting Claim Team Lead for our Corporate location.
***Bachelor’s Degree in Allied Health or a related field or five years of relevant professional experience in the field of Managed Care Contracts and 2 years of Healthcare Claim processing is REQUIRED***
Assists Contract Management Supervisor in coordinating and monitoring activities of the Global Claims Unit. Additionally is responsible for the day to day billing, collection and reimbursement of facility and professional claims related to Payer Relations and Contracting Global admissions, capitated contracts, self-pay/single case and other contract types Assists in providing day to day direction and oversight of claim team quality and productivity, including coaching with feedback while also mentoring and motivating team members to maintain quality and productivity standards. Collaborates with department on identification and analysis of problem areas between UMMC/FPI and Health Plans/Networks and assists with recommendations for solutions.
Principal Responsibilities and Tasks
The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all job duties performed by personnel so classified.
1. Operational Management/Responsibilities
A. Completes the Billing, Collection and Reimbursement process for Global Claims
B. Reports to work during core business hours (8:00 AM to 4:30 PM) on a consistent, regular basis.
C. Attends regular meetings as directed by management and keeps the management team informed of accomplishments and ongoing issues. Participates in achieving resolutions to identified issues.
D. Maintain department quality and productions standards with regards to the Global Claim process. Assist Claim staff with handling and resolving escalated phone calls/issues and provides staff support and advice on the implementation of global and non-standard proves contracts. Responsible for assisting with the implementations of Global contracts. Develops a full understanding of all UMMS Contracts and programs.
E. Assists Management in ensuring and managing Department quality and turnaround time standards.
F. Answers inquiries and prepares written correspondence to internal and external clients regarding claim matters. Appears before internal and external clients to explain the Global Claim process and answer questions regarding claim activities and services.
G. Provide support as technical resources for department, internal and external clients during core business hours on a consistent regular basis.
H. Provide training support for new employees and staff with process workflows and procedures. Works with staff members on identifying training needs. Creates training materials (i.e. policy and procedure manuals, quick reference guides) related to the Global Claim Process. Designs in-service and training programs for clinical and administrative staff (e.g. referral coordinators, billing staff, clinical staff, claim staff, finance staff, etc.) within the clinical departments, hospital and affiliated facilities related to the Global Claim process.
I. Facilitate Payer Appeals process and discussions, create and send appropriate correspondence, when required.
J. Provide a positive, stable, and consistent presence in the work environment.
K. Evaluate and enter reporting data as needed. Assists in maintaining department records and report preparation.
L. Work with other departments to establish and maintain collaborative relationships toward achieving department and company goals
M. Accountable for accepting personal responsibility for the quality and timeliness of work assigned and assumes ownership of the results; maintains high work ethics; takes initiative to actively improve performance.
N. Collaborates well with all levels of personnel, internal and external clients; is innovative by considering original ideas to address issues and resolve problems.
O. Ability to make fast-paced decisions when required and perform deductive/methodical decisions where appropriate.
P. Position requires versatility and flexibility while quickly adapting to change.
Q. Perform other duties as assigned by Management.
R. Assists Management in trouble shooting financial and reimbursement conflicts with Global Claims when necessary. Initiates solutions, involving other resources if warranted.
S. Work with FPI and Hospital revenue enhancement initiatives. Serves as liaison between payer and clinical department for changes in operational or contractual procedures.
As a UMMC employee, and a part of the University of Maryland Medical System (UMMS), you will enjoy a comprehensive benefits program designed with you and your dependents in mind. Subject to any eligibility waiting period, all of the benefits are available to regular full-time employees and most benefits are available to regular part-time employees who are regularly scheduled to work twenty (20) or more hours per week. Many benefits are provided at no cost to employees. For others, the cost is shared between UMMC and employees.
What You Need to Be Successful:
Bachelor’s Degree in Allied Health or a related field or five years of relevant professional experience in the field of Managed Care Contracts and 2 years of Healthcare Claim processing required.
2 years of supervisory experience in medical claim processing/billing or health care operations.
2 years of managed care experience in several of the following areas:
A. Provider Services
D. Network Operations
E. Physician office or hospital experience preferred
Knowledge, Skills and Abilities
1. Possesses strong/broad understanding of the medical claims analyst process, medical terminology and medical claim billing and adjudication. Knowledge of ICD-9 and/or ICD-10 and CPT as related to claim processing is required. Is considered a resource for others as it relates to claims questions and problem-solving.
2. Knowledge of the EPIC application preferred.
3. Knowledge of Medicare, Medicaid, and other government programs required.
4. Excellent oral and written communication skills. —has demonstrated the ability to effectively and professionally communicate information to both internal and external customers. This includes facilitating meetings, conducting training sessions, organizing and documenting workflows and processes, handling escalating calls and/or responding to appeals.
5. Excellent interpersonal and organizational skills.
6. Proficiency in MS Office (Word, Excel, PowerPoint)
7. Ability to work and problem solve independently. Takes the initiative to research and resolve processing and system issues using available resources and without waiting for direction. Views obstacles as encountered opportunities for improvement and offers and solutions.
8. Understands where tasks and assignments fall into the big picture and organizes and prioritizes accordingly. Diligently follows up with managements, peers, other departments and customers.
9. Demonstrated skills in producing technical analysis.
10. Possesses superior Customer Service skills. Seeks to understand expectations of internal and external clients. Knows which questions to ask and what information to verify to get to the root cause of the problem. Outlines options and presents unfavorable information in a manner that demonstrates empathy and reflects a willingness to go the extra mile.
We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.