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| Job
Title: |
Provider Enrollment Coordinator |
| Reference
Number: |
U16023 |
| Location: |
Managed Care |
| Job
Description: |
Job Summary:
Creates and provides reports to numerous CCF Divisions/Departments with the purpose of updating and maintaining all billing and registration masterfile information. Maintains and updates all provider information as requested. Provides data to Out-of-State payors. Functions as a liasion with payors, suppliers and divisions/departments as initial problem solver. Conducts orientation and training for new employees on provider enrollment process. Functions as initial quality assurance monitor for compliance of all processes and procedures. Provides technical support for systems and procedures.
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| Required
Skills: |
Minimum Qualifications:
Has working knowledge of The Cleveland Clinic Foundation (CCF), Patient Access Services (PAS), and Managed Care provider information systems to support Patient Financial Services (PFS), Clinical Divisions/Departments, and Regional Medical Practice (RMP). Provider information systems include Signature, ADTR, HBO, SIS and the Managed Care database. Moderate to extensive knowledge of PC systems, including Microsoft Office and Excel to utilize reports created by Provider Billing Enrollment Auditors in performing audit functions. Excellent verbal and written communication skills. Ability to analyze and prioritize multiple projects. Adapt to the need for change. Ability to interact with multiple payors, suppliers, and Divisions/Departments. Ability to promote sound customer service relationships.
Minimum of four years experience including Utilization Management, Pre-certification, patient registration, patient accounts or equivalent in a financial service, i.e., insurance, physician's office or related hospital environment. CCF experience involving reconciliation of issues related to patient accounts perferred. rolonged sitting, ability to walk moderate distances. Dexterity sufficient to operate a PC with speed and accuracy.
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| Job
Title: |
Project Manager |
| Reference
Number: |
T32006 |
| Location: |
Managed Care |
| Job
Description: |
JOB SUMMARY:
Under the direction of the Division Administrator and the Division's Executive Director, the incumbent functions as a primary resource providing administrative, analytical and managerial support related to activities of the Division of Managed Care for the Cleveland Clinic Foundation and the Cleveland Clinic Health Sytem. Interfaces with all levels of management, both internal and external to the Foundation.
Master's Degree in Business Administration, Health Administration, or related field. |
| Required
Skills: |
Strong working knowledge of health care and business management skills sufficient to perform in-depth research, analytical studies, report preparation, generation of recommendations and development of business plans, experience in business development a plus. Demonstrated ability to lead work groups in the completion of projects as well as ability to work independently. Demonstrated high level ability and working knowledge of computer systems, software applications (i.e., word processing, spreadsheets, database and presentation products) and web technologies. Possess superior research skills and knowledge of health care and business web sites / research databases to conduct indepth research and analysis.
Excellent written and oral communication skills. Demonstrated ability to work effectively with multi-disciplinary professional and technical staff and to maintain a high degree of confidentiality, as well as working independently to ensure project completion. Manages multiple priorities and projects with competing deadlines - spending whatever time necessary to ensure timely completion. Two years experience in a health care environment, closely related health care or business environment or in health care consulting required. Note: Extensive arelated work experience may potentially be considered as substitution for Master's Degree.
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| Job
Title: |
Manager Payor Contract Services |
| Reference
Number: |
T30025 |
| Location: |
Managed Care |
| Job
Description: |
General Summary: Under the direction of Director CCF/CCHS/CHN Payor Contract Services, coordinates the collection and provision of managed care contract information for contract implementation, contract compliance monitoring, contract-related operations and customer service, to provider organizations, facilities and operational areas either directly or in conjunction with other CCF/CCHS/CHN departments. |
| Required
Skills: |
Minimum Qualifications: Bachelor's Degree in business, marketing, or health care administration; Master's degree preferred. Strong working knowledge of managed care contract terms, credentialing, health benefit design, provider relations issues, and medical claims administration. Familiarity with health care accrediting and regulatory agencies, health care delivery models, and financial reimbursement models, in addition to insurer/HMO/PPO operations. Ability to thoroughly research and analyze an issue, prepare a clear and concise report, and make recommendations. Strong desktop computer skills; proficiency with most Microsoft Office applications (Word, Excel, Access, PowerPoint), email and internet. Excellent oral and written communication skills, demonstrated ability to work effectively with multidisciplinary professional and technical staff. Manual dexterity to operate office equipmnet. Ability to life and transport up to 15 pounds. May require exteded periods of standing, walking or sitting. Good visual acuity through normal or corrected vision. Experience: Minimum of five (5) years experience in a managed care, provider relations, physician practice management, health plan or hospital setting with extensive exposure to physician relations and managed care operations. Master's Degree may substitute for two (2) years experience. |
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| Job
Title: |
Sr. Payer Compliance Analyst Managed Care |
| Reference
Number: |
T28125 |
| Location: |
Managed Care |
| Job
Description: |
JOB SUMMARY:
Under the direction of the Director, CCHS Contracting, researches and makes recommendations regarding managed care payer compliance with key terms of current and potential contracts. Manages operational aspects of Contract Management systems on behalf of Business Development. Analyzes financial and operational impact of compliance issues on the Cleveland Clinic Health System Hospitals, Cleveland Clinic Foundation, Cleveland Clinic Health System Physician Organization and Cleveland Clinic Health System Ancillary managed care contracts. Develops competitive comparisons based on compliance issues, and makes recommendations for change. Audits data integrity, accuracy, and reliability. Assists with contract negotiation and document preparation.
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| Required
Skills: |
MINIMUM QUALIFICATIONS:
Knowledge of patient accounting and financial accounting principles, procedures and standards sufficient to perform analytical studies and reconciliation. Strong working knowledge of PC spreadsheets, contract management systems, and databases required. Demonstrated ability to work effectively with multidisciplinary professional and technical staff. Demonstrated ability to maintain a high degree of confidentiality. Minimum five years of patient financial and/or utilization analysis and reporting experience, preferably with some or all related to the managed care industry. Prior experience in a payor or provider environment. Experience in contract document review and reimbursement methodologies. Knowledge of and experience with contract management software systems preferred. Bachelor's degree or equivalent experience required. Master's degree preferred. Manual dexterity to operate office equipment. Ability to lift and transport up to 15 pounds. May require extended periods of standing, walking or sitting. Good visual acuity through normal or corrected vision.
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| Job
Title: |
Manager Data & Contract Performance |
| Reference
Number: |
T32055 |
| Location: |
Managed Care |
| Job
Description: |
JOB SUMMARY:
Under the direction of the Director of Contract Economics. The individual in this role interacts with Managed Care Business Development staff and Cleveland Clinic Administrators to establish and report on quality performance indicators. The incumbent manages the appraisal of fiscal and medical data designed to align the financial and operational incentives of third party payers and healthcare providers. The Manager of Data and Contract Performance assists in the development of the contract pricing strategy and is primarily responsible for the development of the claims database, payer utilization reporting and programs linking outcomes to payment. In addition, the Manager supervises staff responsible for analysis and reporting. The position is required to proactively identify and communicate contract performance information to CCHS Senior Management.
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| Required
Skills: |
MINIMUM QUALIFICATIONS:
Bachelors degree in Business Administration, Healthcare Administration, Information Systems or Finance. Masters degree preferred.
Five to seven years of financial and utilization analysis and reporting experience, preferably in the managed care industry. Prior experience in a payor or provider environment. Knowledgeable in accounting principles, procedures and standards sufficient to perform analytical studies and reconciliation. Demonstrate a working knowledge of medical coding standards, disease mangement strategies and clinical terminology. Working knowledge of financial and legal contract terms, managed care theory, practice, policies and reimbursement strategies, as well as physican and hospital billing and reimbursement practices. Demonstrate ability to work effectively with multidisciolinary professional and technical staff. Strong knowledge and application of PC spreadsheets and relational databases required.
Manual dexterity to operate office equipment. Ability to lift and transport up to 15 pounds. May require extended periods of standing, walking or siting. Good visual acuity through normal or corrected vision.
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| Job
Title: |
Managed Care Information Analyst |
| Reference
Number: |
T26107 |
| Location: |
Managed Care |
| Job
Description: |
JOB SUMMARY: Develops and maintains utilization, medical reports and databases for CHNMCO Care Management Department. Audits data integrity, accuracy and reliability.
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| Required
Skills: |
MINIMUM QUALIFICATIONS: Bachelor’s degree in business or computer sciences. Strong analytical/quantitative skills along with statistical and comparative analysis skills. Must have demonstrated I/S skills with demonstrated spreadsheet (Excel) and database management and programming skills (Access) as well as graphics and word processing experience. Excellent oral and written communication skills and a good understanding of managed care also required. Three years in managed care arena preferred. Sit for prolonged periods of time. Work and move among all departments of CHNMCO. Excellent hand/eye coordination. Lift up to 25 pounds. Manual dexterity to operate personal computers and standard office machines. To transfer information from paper to computer, from computer to computer, and to communicate in person and on the telephone.
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| Job
Title: |
Medicaid Manager |
| Reference
Number: |
T99751 |
| Location: |
Managed Care |
| Job
Description: |
Job Summary:
Under the direction of Senior Director, Managed Care Operations, develops and implements an enterprise wide Medicais participation strategy. Requires familiarity with medical regulatory agency standards. Provides contract information for implementation, contract complicance monitoring, contract-related operations and customer service, to the provider organizations, system hospitals and other CC/CCHS/CHN departments as needed.
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| Required
Skills: |
Minimum Qualifications:
Bachelor's Degree in business, marketing, or health care administration; Master's Degree preferred. Strong working knowledge of managed care contract terms, credentialing, Medicaid benefit design, provider relations issues, and medical claim administration. Recent experience in governmental managed care porgrams. Familiarity with health care accrediting and regulatory agencies, health care delivery models, and financial reimbursement models in addition to insurer/HMO/PPO operations. Ability to throughly research and analyze an issue, prepare a clear and concise report, and make recommendations. Strong desktop computer skills; proficiency with most Microsoft Office apllications (Word, Excel, Access, Powerpoint) email and internet. Excellent oral and written communication skills, demonstrated ability to work effectively with multidisiplinary professional and technical staff.
Minimum of five years experience in managed care especially focused on government (Medicare and Medicaid) programs.
Manual dexterity to operate office equipment. Ability to lift and transport up to 15 pounds. May require extended periods of standing, walking or sitting. Good visual acurity through normal or corrected vision
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| Job
Title: |
Accountant |
| Reference
Number: |
T20006 |
| Location: |
Managed Care |
| Job
Description: |
JOB SUMMARY: This position assists in the development and preparation of corporate level financial reporting, analysis, budgeting and forecasting. Prepares monthly financial reports, and completes financial and statistical surveys. Independently prepares ad hoc reports for upper management. Assists Manager as financial liaison to Administrative Support Divisions
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| Required
Skills: |
MINIMUM QUALIFICATIONS: Knowledge, Skills, and Physical Demands Knowledge of accounting principles, standards and procedures and analytical methodologies sufficient to generate financial reports and analyses independently with a high degree of accuracy. Proficient in the use of microcomputers, with experience with spreadsheets and business graphics software. EXPERIENCE Bachelor's Degree in accounting or finance required. Previous related experience in general accounting preferred.
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