Senior Managed Care Network Operations Specialist - REMOTE

Mercy
tuition reimbursement
United States, Missouri, Chesterfield
Nov 23, 2024
We're a Little Different Our mission is clear. We bring to life a healing ministry through our compassionate care and exceptional service. At Mercy, we believe in careers that match the unique gifts of unique individuals - careers that not only make the most of your skills and talents, but also your heart. Join us and discover why Modern Healthcare Magazine named us in its "Top 100 Places to Work." Overview: Senior Managed Care Network Operations Specialist assists, through site visits, large group presentation and one-on-one interactions with physicians, hospitals and ancillary providers, PHO and network individuals billing offices and patients in realizing our goal to provide high-quality, cost-efficient medical benefits for all our product lines. Senior Managed Care Network Operations Specialist responds to credentialing application requests from payors, as well as overseeing claim, fee schedule and contract language disputes, assisting members with finding network providers and resolving other payor/provider/member related issues as pertaining to contracts. By educating, updating and resolving these problems, the Senior Managed Care Network Operations Specialist helps our providers to develop a positive working attitude toward our products and policies, to maintain strong working relationship with our payor population, as well as serving our members to the best of their abilities. Senior Managed Care Network Operations Specialist shall also oversee the duties of the other Managed Care Network Operations Specialists to ensure all the Mercy payor, provider and member population is being served accordingly in respect to Mercy contracts. Senior Managed Care Network Operations Specialist also assist in site visits to self-funded employers, servicing direct contracts and working with non-contracted employers in promoting Mercy. Ensures the Mercy values are reflected in all aspects of the department's operations. Qualifications: Experience: One-year managed care or health care experience desired with ability to develop and perform. In Lieu of degree, 5 years managed care or health care experience. Required Education: Bachelor's Degree or commensurate experience in lieu of the degree as outlined below. Preferred Education: Understanding of physician office procedures, hospital operations, medical terminology and/or health plan benefits desired. Familiarity with medical coding desired. Requires a highly self-motivated and independent worker who is able to develop and keep own schedule, is able to prioritize assignments and design programs to meet the needs of individual groups and/or offices. Strong interpersonal and communication skills with the ability to design tools which will be useful in educating office staffs and physicians on issues related to Managed Care. Excel or Access knowledge helpful. Preferred Experience: Previous physician office, hospital or insurance company experience in filing/coding claims preferred. Other: Understanding of physician office procedures, hospital operations, medical terminology and/or health plan benefits desired. Familiarity with medical coding desired. Requires a highly self-motivated and independent worker who is able to develop and keep own schedule, is able to prioritize assignments and design programs to meet the needs of individual groups and/or offices. Strong interpersonal and communication skills with the ability to design tools which will be useful in educating office staffs and physicians on issues related to Managed Care. Excel or Access knowledge helpful. We Offer Great Benefits: Day-one comprehensive health, vision and dental coverage, PTO, tuition reimbursement and employer-matched retirement funds are just a few of the great benefits offered to eligible co-workers, including those working 32 hours or more per pay period! We're bringing to life a healing ministry through compassionate care. At Mercy, our supportive community will be behind you every step of your day, especially the tough ones. You will have opportunities to pioneer new models of care and transform the health care experience through advanced technology and innovative procedures. We're expanding to help our communities grow. Join us and be a part of it all. What Makes You a Good Match for Mercy? Compassion and professionalism go hand-in-hand with us. Having a positive outlook and a strong sense of advocacy is in perfect step with our mission and vision. We're also collaborative and unafraid to do a little extra to deliver excellent care - that's just part of our commitment. If that sounds like a good fit for you, we encourage you to apply. EEO/AA/Minorities/Females/Disabled/Veterans