Managed Care Operations Administrator

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. They develop and maintain relationships with health plan liaison personnel (provider relations representatives). They gather 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. They maintain and update reference materials that are provided to all appropriate employees periodically. They ensure that all appropriate operations staff 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 focused resources to work on day-to-day operational issues and focus on training and process improvement. They assist 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 payer healthcare experience is required.

Skills

• Strong communication skills
• Excellent organizational and problem-solving abilities
• Ability to manage multiple tasks and prioritize effectively

Benefits

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.