Under general supervision, participates in the negotiation of Managed Care agreements. Responsible for monitoring and coordinating Managed Care contractual arrangements for all affiliated entities of the medical facility. Analyzes contractual language for functional, financial and ethical appropriateness, determining compliance and consistency with established legal requirements and parameters.

Responsibilities

Responsible for maintaining and resolving payment and contractual issues with assigned payers.

Coordinate meetings with assigned payers to discuss updates and claim issues when necessary.

Participates in reviewing, understanding, and interpreting new and existing Managed Care relationships/contracts, including value based, shared savings and incentive programs for negotiation, renegotiation, and termination (when appropriate).

Establish, track, and maintain letters of agreement (LOA), and single case agreements (SCA) with commercial, Medicaid, and Medicare health plans.

Delivers new and updated fee schedule data that accurately reflects contract language, rates, and intent.

Assists with Payer setup process, education on new and existing payer relationships and coordinates administrative access duties for: Rev. Cycle, department staff to appropriate web portals, and web dashboard related payer tools.

Responsible for disseminating payer updates and changes to the organization.

Communicates Managed Care updates and content within the department and organization through internal systems, including but not limited to: SharePoint, website information, and newsletters.

Builds a collaborative relationship with internal/external staff.

Collaborates with Patient Accounts staff in working on Payer contracts/Claims/Administrative issues.

Performs all other duties as assigned.

Qualifications

Fundamental knowledge of claims processes, medical management processes, medical terminology, and CPT coding.

Fundamental knowledge of reimbursement methodologies, including Fee-for-service (FFS) and Professional Reimbursement. Academic knowledge a plus.

Fundamental knowledge of industry regulations related to contracting and negotiation techniques

Ability to build and maintain positive working relationships, with individual work groups, across departments and external contacts, through open communication and collaboration.

Detailed in documenting information, highly organized, and practices good follow-through techniques.

Proficiency in word processing, spreadsheet, and database software.

Expereince:

Four (4) years experience is required.

Education:

Bachelors Degree in Business Administration or a healthcare field is required.

Required Skills

Four (4) years experience is required.

About Us

Benefits Overview

UT Health San Antonio offers an excellent benefits package for its employees. Employees who work at least 20 hours a week, with an appointment of at least 4.5 months, are eligible for benefits.

Medical - UT SELECT Medical insurance is offered free for employees and administered by Blue Cross and Blue Shield of Texas. Family members can be added to the plan through payroll deduction. Employees and their dependents can also receive discounted copays and coinsurance when using UT Health Physicians, a network of 800 premier physicians including more than 100 specialists.

Dental - Three dental insurance plan options are available for employees and their families through Delta Dental Insurance Company, two PPOs and one dental HMO plan. Both PPO plans allow employees to choose any licensed dentist.

Vision - Fully insured Vision Care benefits are offered by Superior Vision Services. Two vision plan options that offer either standard or enhanced vision benefits. Life Employees receive $40,000 of group term life insurance and $40,000 of basic accidental death and dismemberment insurance for free, with options to purchase additional employee and dependent coverage for both at group rates.

Retirement - Employees are eligible for either the Teacher Retirement System (TRS) or the Optional Retirement Plan (ORP). TRS is a defined benefit retirement plan which UT Health matches employee contributions. ORP is for eligible faculty staff employees. Voluntary retirement programs are also available to invest before- or after-tax dollars with the choice of five quality retirement plan providers.

Time Off - A generous leave program offers multiple paid leave options:

Front-loaded Paid Time Off: 128 to 208 hours (16 to 26 days) of Paid Time Off based on years of service, given at the start of each fiscal year. PTO may be prorated in year one based on date of hire.
Extended Illness Bank: 8 hours (1 day) accrued per month which can be used for illness or injury after one day of Paid Time Off is taken.
Paid Family Leave: Up to 240 hours (6 weeks) to care for a spouse, child, or parent after 6 months of consecutive employment.
Holidays: 12 set paid holidays each year.

FSAs - Employees can enroll in flexible spending accounts (FSAs) to set aside money from earnings before taxes for qualifying dependent day care expenses or out-of-pocket health care expenses.

Discounts - Employees enjoy a range of discounts on services, tickets, and gym membership.

EEO Statement

UT Health San Antonio is an equal employment opportunity and affirmative action employer. It is our policy to promote and ensure equal employment opportunity for all individuals without regard to race, color, religion, sex, gender identity, national origin, age, sexual orientation, disability, or veteran status.

Job Info

Job Identification 3748
Job Category Clinical Programs & Services
Posting Date 02/27/2025, 01:46 PM
Locations 0126 8431 Fredericksburg Rd, San Antonio, TX, 78229, US (Remote)
Apply Before 03/29/2025, 01:46 PM
Degree Level Bachelor's Degree
Job Schedule Full time
Job Shift 8am-5pm Mon-Fri
Organization M3140 - UTHP ADM Managed Care OPS, M3100 - UTHP UT Health Physicians, M1000 - Dean Medical School, UT Health Science Center, UT Health Science Center
Department M3140 - UTHP ADM Managed Care OPS

Job Info

Job Identification 3748
Job Category Clinical Programs & Services
Posting Date 02/27/2025, 01:46 PM
Apply Before 03/29/2025, 01:46 PM
Degree Level Bachelor's Degree
Job Schedule Full time
Job Shift 8am-5pm Mon-Fri
Locations 0126 8431 Fredericksburg Rd, San Antonio, TX, 78229, US (Remote)

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