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Managed Care Manager in Orlando, FL at Aspire Health Partners

Date Posted: 6/12/2018

Job Snapshot

Job Description

JOB PURPOSE:

As a Managed Care Manager at Aspire Health Partners, your job purpose is to be responsible for the administration of contracts the company has with health insurance agencies. Essential job functions are as follows:

  • Manage managed care contracts including service/claims questions from provider enrollment and patient accounts
  • Interpret contractual language and regulatory requirements
  • Become familiar with various reimbursement methodologies, including per diems and understanding of managed care insurance products, including Medicaid and Medicare, and their financial impacts on payors and providers.
  • Most importantly, all functions must be completed while maintaining high standards of ethical and professional conduct while adhering to all company policies and procedures.

Job Requirements

POSITION QUALIFICATIONS:

  • Bachelor’s Degree in Accounting, Business Studies, Business Management or Administration, Finance, or Computer Sciences with at least two years’ experience working in contract management related activities and interfacing with managed care companies and/or governmental entities. Experience in behavioral healthcare is preferred.
  • Ability to interpret contractual language and regulatory requirements
  • Familiarity with various reimbursement methodologies, including per diems
  • Understanding of managed care insurance products and their financial impacts on payors and providers
  • Administering contracts for health insurance plans
  • Building and maintaining relationships with health insurance plans
  • Communicating contractual changes and industry news with internal parties
  • Responsible for maintaining key documents and historical accounts of contracts and communications in a repository
  • Knowledge of provider credentialing is a plus