Operations Specialist Senior

Department:
10802 Advocate Aurora Health Corporate - Medical Education Office

Status:
Full time

Benefits Eligible:
Yes

Hou rs Per Week:
40

Schedule Details/Additional Information:

• Remote position, with occasional on-site presence as needed at our academic medical centers.
• Day schedule, Monday - Friday.

Pay Range:
$33.05 - $49.60

Designs and leads the implementation of managed care contract requirements within Aurora Health Care. Develops and maintains strong business relationships with health insurance organizations while providing a single point of contact for Aurora Health Care revenue cycle business operations. Interacts with all aspects of the revenue cycle operations and insurance carriers to track, trend and resolve payer related issues. Performs root cause analysis and acts as the reimbursement subject matter expert for managed care agreements.

Ensures physician, hospital and ancillary claims are paid according to contract agreements.

• Serves as the key contact for the managed care operations department and effectively communicates with providers, physicians, payers, consultants, agents, and Aurora revenue cycle departments. Ensures that all parties are meeting contractual obligations with respect to operation activities and facilitates positive relationships, problem solving and service improvement recommendations. Provides leadership with trends, feedback and recommendations on closing contract language gaps & opportunities for improving contract performance.
• Builds, updates and ensures the accuracy of the department contract database. Utilizes database to develop detailed standard and ad-hoc reports used to analyze underpayment and over payment issues and to support department projects and initiatives.
• Designs, implements and maintains all aspects of the managed care operations website including product summaries, revenue reimbursement rates, and content accuracy. Responsible for user ability testing and overall site maintenance. Ensures appropriate messaging is applied.
• Leads and guides team members in project management and contract research projects. Defines project plans and goals, performs impact analysis, provides status reports and keeps management apprised to ensure project plans and deliverables are being met.
• Develops and publishes monthly managed care operations department newsletter. Gathers newsletter content, focus topics on relevance, develops and formats newsletter, establishes and test links and documents, adds deletes users DL mailing, follows up and research questions, clarification.
• Facilitates meetings with insurance companies and internal business partners to address issues impacting the business relationship such as payment issues and workflow discrepancies. Works closely with insurance companies to identify process improvement opportunities.
• Accountable for oversight and support of third party software. Monitors software performance and coordinates administrative updates to auditing software, validates appropriate calculations ad rates are accurate.
• Participates in and serves as a subject matter expert in recommending workflow changes to support revenue cycle business needs. Reviews untouched variance opportunities and makes process improvement changes that contribute to more effectively managing the volume and timely review of contracts.
• Acts as a gatekeeper for the Aurora payer dashboard, providing enhancement recommendations, training and access to internal and external stakeholders. Assesses and interprets internal and external partner’s needs, provides guidance and support to meet the requirements.
• Monitors productivity and financial recoveries at the individual and team level to ensure department goals are achieved. Responsible…