Managed Care Operations Administrator

Job Description

Job Description

Responsibilities

At VHC Health, every role contributes to exceptional care, better outcomes, and stronger communities.
In addition to your base compensation, VHC Health offers a comprehensive benefits package, including medical, dental, and vision coverage (subject to eligibility requirements), as well as additional wellness and retirement benefits designed to support our employees and their families.
VHC Health is committed to wage transparency and equitable pay practices. The compensation offered for this position—whether expressed as an annual salary or hourly rate—is determined based on a variety of legitimate, non-discriminatory factors. These factors include, but are not limited to, a candidate’s qualifications, relevant training and experience, skill level, shift differentials (where applicable), internal equity, and current market conditions.
The posted hiring range reflects the range VHC Health, in good faith, believes is appropriate for this role at the time of posting. This range may be adjusted in the future based on business needs or market changes. No portion of compensation is considered earned until it is vested and determined in accordance with the terms of applicable policies and benefit plans. The availability and amount of any bonuses, incentives, or other benefits are subject to the terms of those plans and may be modified at the sole discretion of VHC Health, in accordance with applicable law.
VHC Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to age, color, disability, gender identity or expression, marital status, national or ethnic origin, political affiliation, pregnancy (including childbirth, pregnancy-related conditions and lactation), race, religion, sex, sexual orientation, veteran status, genetic information, or any other characteristics protected by law.
VHC Health maintains a drug-free workplace. The unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited at all VHC Health locations.

Qualifications

Purpose & Scope:

The Managed Care Operations Administrator is a day to day liaison between the hospital and the health plans with which the hospital contracts. Develop and maintain relationships with health plan liaison personnel (provider relations representatives). Gathers information from health plan liaison, websites, newsletters and other publications regarding health plan policies and procedures that impact the hospital’s provision of services and reimbursement. Maintains and updates reference materials that is provided to all appropriate employees periodically. Ensures that all appropriate operations staffs have access to and train on health plan on-line systems. This position provides focused training to departments on managed care contracts and health plan policies and procedures to improve compliance. This position also develops materials and does training on EPIC payers and plans to improve accuracy of registrations. The purpose of this position is to provide a focused resources to work on day to day operational issues and focus on training and process improvement. Assists the Managed Care Operations Director in all of his/her duties.

Education:

Bachelor's degree in healthcare management or in a related field is required.

Master's degree in healthcare administration, business, or equivalent experience is preferred.

Experience:

Five years of provider or payor healthcare experience required.

Certification/Licensure:

None.