Managed Care Coordinator

Managed Care Coordinator

Become part of an inclusive organization with over 40,000 teammates, whose mission is to improve the health and well-being of the unique communities we serve.

UNC Health is hiring a full-time Managed Care Coordinator to join our team! Our ideal candidate will have:

• Epic Hospital Billing or Professional Billing Expected Reimbursement Contracts Administration certification or similar proficiency in other vendor software.
• Overall general understanding of Healthcare Revenue Cycle processes
• Epic Hospital Billing Experience or similar in other vendor software. Specifics as follows:
• Resolving insurance payment variances
• Understanding of insurance payer reimbursement terms and billing to support
• Strong understanding of insurance payment process/posting of payer remittance information

Summary

The Managed Care Coordinator is a key member of the Contract Administration team. This role is responsible for maintaining accurate reimbursement calculations, performing payment variance analysis, supporting ad hoc reporting needs, and assisting with contract modeling and negotiation activities. The position plays an important role in ensuring payer contracts are accurately reflected in billing systems and that financial outcomes align with contractual expectations.

Responsibilities

As part of the Contract Administration team, the Managed Care Coordinator will be responsible for the following:

1. Billing Reimbursement Configuration and Maintenance Build, maintain, and troubleshoot expected Hospital, ASC, and Ancillary reimbursement calculations within Epic for both governmental and commercial payers. This includes ensuring that reimbursement logic is accurately loaded and aligned between Epic and payer systems. Responsibilities include implementing routine updates such as quarterly drug fee schedules, annual payer rate increases, and annual fee schedule updates. Technical capabilities include building contracts in the Epic POC environment and utilizing Content Manager for data couriering to PRD. The role requires obtaining the Epic RHB390 Hospital Billing Expected Reimbursement Contracts certification within the first 90 days.
2. Contract Modeling and Negotiation Support Support major payer negotiations by developing and analyzing contract modeling scenarios. Using Managed Care–developed tools, proposed commercial payer rates are modeled across all UNC Health entities to assess expected financial impact. Results are summarized and presented to financial and operational leadership to support data-driven decision-making.
3. Contract Validation and Variance Analysis Validate contract builds by performing payment variance analysis to ensure contracted reimbursement terms are correctly implemented and functioning as expected. Identify discrepancies and collaborate with internal teams to resolve issues.

Education Requirements: Bachelor's degree in relevant field Licensure/Certification Requirements: No licensure or certification required. Professional Experience Requirements: If Bachelor's degree, requires two (2) years of experience with managed care contracts and provider relations. If Associate's degree, requires six (6) years of experience with managed care contracts and provider relations. If High School diploma or GED, requires ten (10) years of experience with managed care contracts and provider relations. If Master's degree, requires zero (0) year of experience Knowledge/Skills/and Abilities Requirements: