The Managed Care Specialist is responsible for assisting with the internal maintenance of MDN provider data integrity related to Cedars-Sinai Medical Delivery Network on behalf of Cedars-Sinai Medical Care Foundation and group. In this role, the incumbent is responsible for processes associated with internal audit as it relates to the financial, contracting and reimbursement functions of the Cedars-Sinai Medical Delivery Network including Cedars-Sinai Medical Care Foundation and affiliated medical groups. The Managed Care Financial Specialist assists the organization in maximizing revenue and decreasing costs.
Duties and Responsibilities:
- Reviews Provider Information Forms (PIFs) related to the MDN’s managed care business operations (provider networks, HMO referrals, claims, contracts)
- Maintains the MDN’s all downstream provider contract grids
- Responsible for communicating changes to downstream provider agreements to our current third party MSO
- Assists Manager in resolving discrepancies in provider contract records within EPIC’s Tapestry Module and associated HMO referral system(s);
- Maintains internal rosters to mitigate inadvertent leakage resulting from incorrect listings
- Provides paneling information provided to Health Plans is accurate and timely to support Senate bill AB137
- Conducts routine audits of provider updates
- Assists with the implementation of new or amended ancillary and provider contracts.
- Works with Contracting team to determine financial implication of identified discrepancies
- Periodically audit payor reports and provider listings to ensure accurate and complete participation of MNS-represented physician networks.
Education:
High school diploma/GED required. Bachelor's degree in related field preferred.
Experience:
One (1) year of relevant work experience in healthcare, finance, decision support or accounting departments required.
Two (2) years of Managed Care, experience in Financial Operations and various reimbursement methodologies required.
Three (3) years of Managed Care, experience in Operations within a Medical Group or IPA in claims accounting; experience in interpreting financial data required.
Cedars-Sinai is a leader in providing high-quality healthcare encompassing primary care, specialized medicine and research. Since 1902, Cedars-Sinai has evolved to meet the needs of one of the most diverse regions in the nation, setting standards in quality and innovative patient care, research, teaching and community service. Today, Cedars- Sinai is known for its national leadership in transforming healthcare for the benefit of patients. Cedars-Sinai impacts the future of healthcare by developing new approaches to treatment and educating tomorrow's health professionals. Additionally, Cedars-Sinai demonstrates a commitment to the community through programs that improve the health of its most vulnerable residents.
With a growing number of primary urgent and specialty care locations across Southern California, Cedars-Sinai’s medical network serves people near where they live. Delivering coordinated, compassionate healthcare you can join our network of clinicians and physicians to improve the healthcare people throughout Los Angeles and beyond.
Req ID : 12851
Working Title : Managed Care Specialist - Contracting
Department : MNS Contracting
Business Entity : Cedars-Sinai Medical Center
Job Category : Strategic Plan / Business Dev
Job Specialty : Managed Care
Overtime Status : EXEMPT
Primary Shift : Day
Shift Duration : 8 hour
Base Pay : $24.65 - $38.21
