Managed Care Payment Integrity Liaison

About the Job The Managed Care Payment Integrity Associate will bridge the gap between managed care and revenue cycle, ensuring accurate reimbursement and minimizing payment delays. This position focuses heavily on analyzing, resolving, and preventing denials and underpayments from commercial, Medicare, and Medicaid payers. In addition, the Associate will track payer policies and inform key stakeholders of the operational and financial impact of any changes. Primary Duties and Responsibilities Lead investigations into denial trends and payment discrepancies related to managed care contracts, escalating claims and holding payers accountable for resolution. Update payer‑specific escalation logs with timely and informative data. Collaborate with payer representatives to resolve systemic underpayments and denials, and develop and maintain payer‑specific denial prevention strategies. Track and review updates from payers—including policy bulletins, coverage determinations, medical necessity guidelines, coding updates, and reimbursement rule changes—maintaining a comprehensive database of policy changes with effective dates, impacted services, and required organizational actions. Analyze the potential operational, financial, and compliance impacts of new or revised policies and communicate them appropriately to key stakeholders. Proactively identify and address operational issues with payers, gathering feedback from Revenue Cycle teams regarding contract implementation and performance. Actively participate in all payer meetings focused on claim issue resolution. Maintain effective working relationships and communications with internal staff, MedStar Health leaders, and external managed care payers. Minimal Qualifications Education Bachelor's degree in Healthcare Administration, Finance, Business, or related field required; Associate's degree with 12‑15 years of relevant experience required. Experience 5‑7 years of experience in both managed care operations and/or tertiary hospital revenue cycle required. Deep understanding of managed care reimbursement models (DRG, APC, per diem, etc.) required. Strong working knowledge of denials, underpayments, and appeals workflows as well as billing compliance and payer policies required. Experience with all forms of managed care plans and commercial payer negotiations preferred. Familiarity with payer portals and contract modeling tools preferred. Familiarity with Maryland's Health Services Cost Review Commission preferred. Familiarity with EPIC preferred. Knowledge, Skills, and Abilities Hospital billing systems. Communication, collaboration, and critical thinking skills. Microsoft Excel proficiency. Hiring Range USD $65,062.00 - USD $117,291.00 /Yr. #J-18808-Ljbffr MedStar Health