Renowned as the academic flagship of the University of Maryland Medical System, our Magnet -designated facility is a nationally recognized, academic medical center with opportunities across the continuum of care. Come join UMMC and discover the atmosphere where talents and ideas come together to enhance patient care and advance the science of nursing. Located in downtown Baltimore near the Inner Harbor and Camden Yards, you won’t find a more vibrant place to work!

Managed Care Alternative Rate Analyst II
Full Time, Monday - Friday (8am - 4:30pm)
Baltimore, MD

The University of Maryland Medical System is a 14-hospital system with academic, community and specialty medical services reaching every part of Maryland and beyond. UMMS is a national and regional referral center for trauma, cancer care, Neurocare, cardiac care, women’s and children’s health and physical rehabilitation. UMMS is the fourth largest private employer in the Baltimore metropolitan area and one of the top 20 employers in the state of Maryland. No organization will give you the clinical variety, the support, or the opportunities for professional growth that you’ll enjoy as a member of our team. UMMS is currently seeking a Managed Care Alternative Rate Analyst II for our Corporate offices in Linthicum, MD.

General Summary

Under general supervision, is responsible for the operations and bundling of services included in Alternative Rate Methodology (ARM) Global Contract cases for transplants and other specialized services including Financial Case Management through the continuum of care included in the global coverage period. In addition, the level 2 is also responsible for documenting workflows, providing reporting and research, and training and mentoring junior team members.

Principal Responsibilities and Tasks

The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all job duties performed by personnel so classified.

Coordinates and manages all operational functions of ARM Global contracts including:

Liaison for UMMC, UM Facility Physicians , and Network Transplant Contacts

• Coordinate with multiple physician groups, hospital and insurance networks, third party administrators, and payers regarding status and eligibility for coverage of transplant related services and procedures. Answers inquires and makes recommendations for optimizing operations.
• Communicate with internal and external customers including nurses, providers, Transplant Networks and Payers, Customer Service Representatives, Supervisors, Managers, etc. through telephone inquiries, electronic communication, FAX and letters.
• Work directly with Payers and Transplant Networks to ensure that all contracted services are appropriately financially managed by all entities.

Financial Case Management

• Follow/maintain standard operating procedures for financial case management of all managed care global contracts.
• Maintain existing tracking grid for potential new referrals for transplant services and remove ineligible patients
• Work directly with transplant program Financial Coordinators and clinical staff to determine appropriate phase of care.
• Monitor Financial Classes, patient registration, billing/reimbursement statuses. Manage work queues and financial class change requests, coordinating the timing of update activities in multiple systems including Hospital, Physician, and MCAS web-based billing systems to ensure timely opening and closure for each global period and phase of care.

Bundle Contract Billing

• 
  Bundle and process billing of complex cases including hospital and physician services covered under global contract to maximize revenue for each case.
• Manage electronic and paper transplant related facility and professional accounts received by Payer Relations and Contracting for multiple Global Transplant contracts.
• Review cod

Education and Experience

• Minimum of 6 years of experience in healthcare financial administration including 2 years of experience accessing/using Payer electronic tools to communicate/investigate provider claim and patient eligibility status.
• AA degree preferred.
• Preferred knowledge of Hospital and/or Physician:

• Managed Care and bundle billing practices.
• claim processing
• insurance coverage registration
• billing and collections (AR)
• reimbursements and payments (AP)

Knowledge, Skills and Abilities

• Knowledge of medical terminology and health care coding including ICD10, CPT, DRG, Bill Types, etc.
• Knowledge of Payer claims processing (Medicaid, Commercial, Medicare Network/Third Party Administrators/Client Networks), Hospital and Physician account management, bundled billing concepts, managed care contracts, global rate and fixed reimbursement, and coordination of benefits.
• Understanding of Hospital and Physician patient registration concepts and workflows.
• Demonstrated ability to work in multiple patient management applications.
• Demonstrated ability to work both in teams and independently.
• Demonstrated ability to set goals, prioritize, and coordinate the execution of multiple tasks within a specified time frame.
• Demonstrated ability to use personal computers and related software, such as Microsoft Windows, Word, and Excel.
• Demonstrated ability to perform basic mathematical calculations, including; addition, subtraction, multiplication, division, and percentages using a calculator or related equipment.
• Demonstrated proactive problem-solving skills. Detail oriented with analytical ability to interpret data and related information, discern trends and tendencies, and determine appropriate courses of action. Strong organizational skills are necessary.
• Highly effective verbal communication skills, including courtesy, resourcefulness and efficiency in answering questions, requesting information, providing information, and explaining billing and collections policies and procedures are required. Effective business writing skills are required.

All your information will be kept confidential according to EEO guidelines.