Reimbursement Specialist, Managed Care

BJC Healthcare Saint Louis , MO 63150

Posted 3 weeks ago

Job ID: 1206867

Employment Status: Full-Time

More Information:

BJC HealthCare is one of the largest nonprofit health care organizations in the United States, delivering services to residents primarily in the greater St. Louis, southern Illinois and mid-Missouri regions. BJC serves patients and their families in urban, suburban and rural communities through its 15 hospitals and multiple community health locations. Services include inpatient and outpatient care, primary care, community health and wellness, workplace health, home health, community mental health, rehabilitation, long-term care and hospice.

Includes Provider Relations staff who develop and maintain processes for improvement for the communications between the health plans and BJC entities and resolution of issues in a timely manner. Managed Care contracting resolves plan issues through contract language, and conducts an on-going process for monitoring BJC entity communications regarding managed care contracts and the impact on BJC entities. Represents BJC hospitals to managed care companies for contracting and provider relations. Works with Managed Care Finance to evaluate the financial impact of rate proposals, assuring the financial advantage of each contract. Provides plan administration for second level appeals and serve as the primary technical liaison with the TPA that administers BJC's self-insured health plan.

Overview

Role Purpose

Responsible for performing the functions required of Contract Management Application (CMA) that ensure data integrity and to assist in the data mining of that application.

Responsibilities

Provides analytical support for reimbursements to management and facilities.Assists with completing data mining through contract application systems.Maintains data integrity for contract application systems.

Minimum Requirements

Degree

High School Diploma or GED

Experience

2-5 years

Supervisor Experience

No Experience

Preferred Requirements and Additional Job Information

Experience

5-10 years

Benefits Statement

Note: not all benefits apply to all openings

  • Comprehensive medical, dental, life insurance, and disability plan options

  • Pension Plan*/403(b) Plan

  • 401(k) plan

  • Tuition Assistance

  • Health Care and Dependent Care Reimbursement Accounts

  • On-Site Fitness Center (depending on location)

  • Paid Time Off Program for vacation, holiday and sick time

  • Pension does not apply to Memorial Hospital, Memorial Hospital East, Memorial Medical Group, Alton Memorial or Parkland Health Center

Legal Statement

The above information on this description has been designed to indicate the general nature and level of work performed by employees in this position. It is not designed to contain or be interpreted as an exhaustive list of all responsibilities, duties and qualifications required of employees assigned to this job.

Equal Opportunity Employer

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VIEW JOBS 10/5/2020 12:00:00 AM 2021-01-03T00:00 Job ID: 1206867 Employment Status: Full-Time More Information: BJC HealthCare is one of the largest nonprofit health care organizations in the United States, delivering services to residents primarily in the greater St. Louis, southern Illinois and mid-Missouri regions. BJC serves patients and their families in urban, suburban and rural communities through its 15 hospitals and multiple community health locations. Services include inpatient and outpatient care, primary care, community health and wellness, workplace health, home health, community mental health, rehabilitation, long-term care and hospice. Includes Provider Relations staff who develop and maintain processes for improvement for the communications between the health plans and BJC entities and resolution of issues in a timely manner. Managed Care contracting resolves plan issues through contract language, and conducts an on-going process for monitoring BJC entity communications regarding managed care contracts and the impact on BJC entities. Represents BJC hospitals to managed care companies for contracting and provider relations. Works with Managed Care Finance to evaluate the financial impact of rate proposals, assuring the financial advantage of each contract. Provides plan administration for second level appeals and serve as the primary technical liaison with the TPA that administers BJC's self-insured health plan. Overview Role Purpose Responsible for performing the functions required of Contract Management Application (CMA) that ensure data integrity and to assist in the data mining of that application. Responsibilities Provides analytical support for reimbursements to management and facilities.Assists with completing data mining through contract application systems.Maintains data integrity for contract application systems. Minimum Requirements Degree High School Diploma or GED Experience 2-5 years Supervisor Experience No Experience Preferred Requirements and Additional Job Information Experience 5-10 yearsBenefits Statement Note: not all benefits apply to all openings * Comprehensive medical, dental, life insurance, and disability plan options * Pension Plan*/403(b) Plan * 401(k) plan * Tuition Assistance * Health Care and Dependent Care Reimbursement Accounts * On-Site Fitness Center (depending on location) * Paid Time Off Program for vacation, holiday and sick time * Pension does not apply to Memorial Hospital, Memorial Hospital East, Alton Memorial or Parkland Health Center Legal Statement The above information on this description has been designed to indicate the general nature and level of work performed by employees in this position. It is not designed to contain or be interpreted as an exhaustive list of all responsibilities, duties and qualifications required of employees assigned to this job. Equal Opportunity Employer BJC Healthcare Saint Louis MO

Reimbursement Specialist, Managed Care

BJC Healthcare