Operations Manager (Managed Care) – Boynton Beach, FL

Position Summary:
We have an exciting opportunity to join our team as a Operations Manager – Managed Care.

Position Summary:
Responsible for providing education, training and support related to all aspects of Managed Care to physician practice staff, Access Center staff and management, as well as to those in the Central Billing Office and FGP Administration. The Manager will partner with internal resources to implement operational changes and workflows needed to ensure compliance with payer policies. The Operations Manager will act as a liaison between managed care payers and the Faculty Group Practice business staff and clinical departments. The Manager will assist and intervene as needed when issues need to be escalated to payers regarding patient care. The Operations Manager will facilitate a direct communication to commercial payers to advocate for front end staff when faced with barriers related to authorizations or denials for clinical services, verification of patient eligibility or clarification of payer policies. This role actively provides feedback and guidance throughout the institution by responding timely and accurately to the #Askmanagedcare inbox. The Operations Manager is actively involved in the transition and onboarding planning of new practices and physicians into the Faculty Group Practice. The Manager develops relationships with practice staff to educate and train on all front end related issues relevant to managed care including referral and authorization requirements, Payer/Plan selection in Epic for accurate registration, primary care paneling and referral issues and any other operational workflows that provide for the smooth flow of patients throughout the practices. The role will also understand the relevance of the Real Time Eligibility function in Epic for automated registration and assist in the development of new RTE mappings and troubleshooting when the system is not operating as expected. The Operations Manager is responsible for the maintenance of internal Managed Care website. The Manager will routinely update the information and tools available on the website and ensure the objective is met for the site to provide easy access to material that is current, concise and displayed and drafted in a manner that can be useful for all front and back end staff. The Operations Manager plays a key role in training new and current staff in the classroom setting as well as over large scale webex presentations. The role is responsible for drafting content for and leading regularly scheduled FGP Operations calls and regularly scheduled Managed Care training classes held throughout the year. The Operations Manager shall act in the role of subject matter expert regarding front end operations and help facilitate the resolution of the day to day challenges that commercial payer polices may impose on the backend revenue cycle or the frontend goal for patients to receive timely care without administrative delays.

Job Responsibilities:

• Acts as liaison and advocate between FGP practices and Managed Care plans to educate practices about operational policies and procedures impacting the daily operations of the practice.
• Assist in the monitoring of the RTE functionality in Epic. Help identify issues caused when the RTE function is not working properly. Assist in the data mining and research needed to map new RTE responses.
• Maintains proficiency in Epic Payer/Plan assists in ensuring that all managed care plans are built correctly and accurately in the system. Assists in the identification and research needed to maintain and build new plans as needed.
• Assists Managed Care leadership in any strategic planning and analytical support needed for managed care contracting opportunities
• Works collaboratively with FGP Reimbursement Analysts to assist in contract compliance activities related to incorrect patient registration. Educates and trains analytical staff on registration nuances and acts on data mined from compliance reports to root cause repetitious registration errors.
• Leads training classes and scheduled front end Managed Care related WebEx calls. Collaborates on the development of the training curriculum related to Managed Care and coordinates with Epic IT training to cover all necessary content.
• Maintains and updates content on the FGP Managed Care website
• Drafts content for institution wide distribution related to payer policy changes. Strategizes with internal departments to determine changes to operations needed to implement workflows need to ensure compliance to new policies and procedures.
• Performs other duties as assigned and needed to support the Office of Managed Care and Faculty Group Practice.

Minimum Qualifications:
To qualify you must have a Bachelors Degree, a minimum of three to five years in a physician office, hospital or managed care environment. Proficient in the use of Excel and Word. Knowledge of claims processing systems and guidelines. Ability to analyze problems, draw relevant conclusions, and devises appropriate courses of action. Excellent analytical, interpersonal and organizational skills required

Preferred Qualifications:
Preferred Qualifications:
Masters degree in Health Care, Public Health Administration or Business Administration. One to two years of physician relations experience in an HMO, IPA or large group practice setting. Superior customer service skills.

Qualified candidates must be able to effectively communicate with all levels of the organization.

NYU Langone Florida provides its staff with far more than just a place to work. Rather, we are an institution you can be proud of, an institution where you’ll feel good about devoting your time and your talents. At NYU Langone Health, we are committed to supporting our workforce and their loved ones with a comprehensive benefits and wellness package. Our offerings provide a robust support system for any stage of life, whether it’s developing your career, starting a family, or saving for retirement. The support employees receive goes beyond a standard benefit offering, where employees have access to financial security benefits, a generous time-off program and employee resources groups for peer support. Additionally, all employees have access to our holistic employee wellness program, which focuses on seven key areas of well-being: physical, mental, nutritional, sleep, social, financial, and preventive care. The benefits and wellness package is designed to allow you to focus on what truly matters. Join us and experience the extensive resources and services designed to enhance your overall quality of life for you and your family.

NYU Langone Florida is an equal opportunity employer and committed to inclusion in all aspects of recruiting and employment. All qualified individuals are encouraged to apply and will receive consideration. We require applications to be completed online.

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