Managed Care Contract Auditor, Full-time, Days (Hybrid)

At Northwestern Medicine, every patient interaction makes a difference in cultivating a positive workplace. This patient-first approach is what sets us apart as a leader in the healthcare industry. As an integral part of our team, you'll have the opportunity to join our quest for better healthcare, no matter where you work within the Northwestern Medicine system. At Northwestern Medicine, we pride ourselves on providing competitive benefits: from tuition reimbursement and loan forgiveness to 401(k) matching and lifecycle benefits, we take care of our employees. Ready to join our quest for better?

Description

The Managed Care Contract Auditor reflects the mission, vision, and values of NMHC, adheres to the organizations Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards.

Responsibilities:

• Liaison between Revenue Cycle and the managed care payors in the escalation of revenue cycle issues that prevent NM from realizing correct reimbursement in accordance with the managed care contracts.
• Collaborates with many internal departments to gather payor issues to escalate and work with payor to resolve. Internal departments include but are not limited to: Patient Accounting, Access, UM, QU, Compliance, Legal, Risk management, clinical areas, IT, Medical Records, CVO, Quality.
• Works with external Revenue Cycle Vendors and consultants when directed to for project work or resolution of payor issues.
• Responsible for validating contract rates and rate language loaded into EPIC in conjunction with MC Specialist prior to contracts being uploaded into the live environment.
• Responsible for understanding the terms of the managed care contracts assigned to be able to assist other areas when needed.
• Investigates issues to understand root cause and makes recommendations for resolutions.
• Looks to see if issues are more systemic in nature.
• Responsible for holding regularly scheduled meetings with Revenue Cycle to review outstanding payor issues.
• Responsible for coordinating monthly payor meetings with Revenue Cycle teams and payor representatives to bring issues to resolution.
• Performs special projects related to AR or payor contracts as assigned by Director.
• AA/EOE.

Qualifications

Required:

• Bachelor's degree or three years of relevant experience.
• Working knowledge of hospital billing language.
• Strong personal computer skills (Word, Excel, PowerPoint, hospital revenue cycle system).
• Excellent verbal and written communication skills.
• Critical thinking and problem solving skills.
• Strong financial aptitude and business acumen.
• Excellent interpersonal skills.
• Excellent written and oral communication skills.
• Proficiency in data analysis.

Preferred:

• Bachelor's degree.
• Technical competence in managed care contract knowledge.

Equal Opportunity

Northwestern Medicine is an affirmative action/equal opportunity employer and does not discriminate in hiring or employment on the basis of age, sex, race, color, religion, national origin, gender identity, veteran status, disability, sexual orientation or any other protected status.