Managed Care Coordinator

Description

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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.

Other information:
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:

Legal Employer: NCHEALTH

Entity: Shared Services

Organization Unit: Managed Care

Work Type: Full Time

Standard Hours Per Week: 40.00

Salary Range:$28.87 - $41.50 per hour (Hiring Range)

Pay offers are determined by experience and internal equity

Work Assignment Type: Remote

Work Schedule: Day Job

Location of Job: US:NC:Morrisville

Exempt From Overtime: Exempt: Yes

This position is employed by NC Health (Rex Healthcare, Inc., d/b/a NC Health), a private, fully-owned subsidiary of UNC Health Care System, in a department that provides shared services to operations across UNC Health Care; except that, if you are currently a UNCHCS State employee already working in a designated shared services department, you may remain a UNCHCS State employee if selected for this job.

Qualified applicants will be considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, status as a protected veteran or political affiliation.

UNC Health makes reasonable accommodations for applicants' and employees' religious practices and beliefs, as well as applicants and employees with disabilities. All interested applicants are invited to apply for career opportunities. Please email applicant.accommodations@unchealth.unc.edu if you need a reasonable accommodation to search and/or to apply for a career opportunity.