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Insurance Contract Manager

Category

Administration

Organization:

Rural Health Group Inc

Location:

Roanoke Rapids, North Carolina • Halifax County

Date Needed:

January 24, 2022

Organization Website:

Type Of Position:

Full Time

Education Required:

Bachelor's

Experience Required:

3-5 year(s)

Date Of Job Posting:

December 23, 2021

Job Description:

Rural Health Group, Inc., a thriving FQHC/Community Health Center serving multiple counties in northeastern North Carolina, is seeking an experienced Insurance Contract Manager to assist our billing/revenue department with provider credentialing/enrollment, processing, and billing services. This full-time position will be based in Roanoke Rapids, NC. RHG is a well-established, primary healthcare practice group that started over 40 years ago. Our 350+ employees provide excellent quality health care to our communities through:

15 Family Practice and/or Internal Medicine offices, OB/GYN office, Pediatrics office, School Based Health Center Program
3 Dental offices
3 In-House Pharmacies, 340B pharmacy program
Integrated Behavioral Health (Psychologists/LCSWs)
Case Management, Care Managers
Community-Based Outreach Program: Migrant/Seasonal Farm Worker, Health Education, Insurance Outreach…

ESSENTIAL JOB DUTIES AND RESPONSIBILITIES

References and connects RHG with existing insurances to educate staff in quality measures, documentation guidelines in an effort to maximize cash flow.
Will become RHG main contact with insurances to ensure maximum contract success;
Acts as an ongoing resource to providers for quality improvement via regular touch points and meetings
Educates, supports, and resolves provider practice sites issues around P4P (Pay for Performance), Disenrollments, Appeals, and Grievance
Collaborates with Provider Relations and other provider facing teams to improve provider performance in Quality (Clinical and Member Experience measures)
Provides clear insight into provider group dynamics, identifies areas of opportunity, builds action plan and collaborates cross functionally to support quality performance
Develops, enhances and maintains provider relationship across all product lines (Medicare, Medicaid, BCBS)
Supports the development and implementation of quality improvement interventions in relation to Plan providers
Analyze and evaluate health plan performance using qualitative and quantitative methodologies, producing actionable and insightful reports and visualizations addressing population health quality opportunities
Responsible for connecting with plan providers regarding quality initiatives and key quality performance indicators
Shares HEDIS, CAHPS, HOS, Part D and Administrative Operations reports and gap lists with providers
Incumbents possess a degree of knowledge and proficiency sufficient to perform advanced-level work and may provide work direction and training to others
The successful candidate will demonstrate the Rural Health Group Core Competencies, which include:

Good Judgment
Communication/Customer Service/Teamwork
Passion
Honesty
Responsibility
Job-Specific Skill Set

QUALIFICATIONS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily
Education Details: population health, public health, healthcare administration, business administration, health policy, economics, statistics, mathematics, data science, or a related field;
In lieu of a Bachelor’s degree, an additional 4 years of relevant work experience is required in addition to the required work experience
Certification in Quality or Process Improvement Methods
Direct experience with accreditation, HEDIS, CAHPS and other quality related activities a healthcare related environment and/or payor organization data analytics experience working with large data sets to answer clinical, operational, or business questions; prior experience with healthcare data expected
Expertise in qualitative and quantitative data analyses and presentations
End-to-end experience designing, developing, and implementing innovative strategies to improve population health
Knowledge of healthcare claims, survey, clinical, and health data
Must be eligible to work in the U.S. without Sponsorship
Embraces the team concept; encourages and models healthy, productive team behavior.
High-energy, organized, persistent individual with strong communications, interpersonal, and systems thinking skills.
Ability to maintain confidentiality at all times.
Ability to function effectively, independently, and efficiently in a stressful and dynamic work environment. Must be able to take initiative, handle high volume and multiple tasks, and appropriately prioritize activities.
Communications/Interpersonal Abilities: Communicates effectively with all levels of personnel and both internal and external customers, develops and maintains collaborative relationships. Ability to establish and maintain positive, effective, professional relationships with all internal and external contacts. Ability to read and interpret documents, write correspondence, and present ideas effectively.
Organization: Able to organize complex information, electronic and paper systems. Must be highly organized and detail oriented.
Ability to use good judgment when carrying out responsibilities.
Computer Skills: Strong computer skills including typing, use of EMR and Microsoft Office programs, particularly Word, Excel, Outlook. Ability to quickly learn new software programs. Database experience a plus.
Reliable attendance.
Possess knowledge of modern office equipment, systems and procedures.
CPR/First Aid
The physical/mental demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disability to perform the essential functions. Physical demands: Ability to sit for long periods of time. Ability to stoop, bend, use computer keyboard and perform light lifting. Moderate physical activity such as walking and traveling. Regularly required to talk and hear, stand, walk, balance on two feet, reach with arms and hands, and use fine motor skills. Occasionally required to climb, kneel and crouch. May occasionally lift and/or move 25+ pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus. Mental demands include: concentration and attention to detail, self-direction, the ability to learn and adapt to changes, exercise discretion and good judgment, exhibit courteous and professional behavior, deal with stressful situations, and to adhere to company policies and procedures.
Competitive salary based on experience; benefit package for full-time employees includes available Medical, Dental, Life, Disability, Vision, Accident, Cancer, and 403(b) retirement plan.

EOE. Federal and State Criminal Background Checks and Drug Screen required for all positions. COVID-19 and Influenza vaccines are conditions of employment.

E-Verify Notice: After accepting employment, new hires are required to complete an I-9 form and present documentation of their identity and eligibility to work in the United States.

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