Catholic Health Services of Long Island (CHS) is an integrated health care delivery system with some of the region's finest health and human services agencies. CHS includes six hospitals, three skilled nursing facilities, a regional home nursing service, hospice and a multiservice, community-based agency for persons with special needs. Under the sponsorship of the Diocese of Rockville Centre, CHS serves hundreds of thousands of Long Islanders each year, providing care that extends from the beginning of life to helping people live their final years in comfort, grace and dignity.
Duties and Responsibilities
Responsible for maintaining and updating managed care contract rate grids
Assists in the maintenance of Joint Operating Committee action plans and follow ups.
Works with relevant parties to ensure deliverable from all parties are achieved in accordance with strategic timelines.
Maintains CHSLI master list of service locations (facility, professional and continuing care)
Assists in the resolution of referral, authorization and claims payment issues
Supports Directors in effort to educate and assist Hospital departments in meeting internal and MCO operational requirements. Informs departments of contract terms as necessary
Responsible for the completion of facility credentialing for managed care payers. Accurately maintains all facility credentialing files
Assists Directors in payer research for new programs/services
Assists in the maintenance contractual term matrix and contact grids
Assists in the coordination of payer in-services
Disseminates quarterly payer policy updates
Maintains and updates contact and plan participation grids
Maintains Payer Contracts
Tracks single case agreement through execution process
Coordinates Center of Excellence application correspondence.
Educates and assists CHSLI employees in meeting internal and MCO operational requirements. Informs departments of contract terms for all entities
Works with Revenue Cycle team to identify and resolve issues related to timely payment of managed care claims.
Assists SVP and VP on projects as assigned
Position Requirements and Qualifications
EDUCATION: Bachelor's degree required.
Proficient in designing, building reports and analyses in various Microsoft based data analysis tools.
Proven experience working with large and complex SQL databases preferred.
Ability to analyze and accurately summarize complex claims data and effectively communicate conclusions
Proficient in project management
Detail oriented and strong organization skills
Previous experience with analysis preferably in a healthcare or managed care setting.
Experience with hospital billing and or decision support systems a plus.
Strong knowledge of the managed care environment including provider, payer, and employer.
At Catholic Health Services of Long Island your well-being comes first, with comprehensive compensation and benefits; our offerings go beyond the basics. In addition to multiple medical plans, life insurance, generous paid time off and flexible spending accounts, we also offer substantial tuition reimbursement, an employer funded pension plan and several savings plan options for your future.
St. Catherine Of Siena