2 insurance jobs found in Raleigh

Overview: The Managed Care Operations Lead serves as a resource and advisor, directs all aspects of managed care operations including system wide credentialing with managed care plans, contract performance monitoring and reporting, and contract payment modeling and analysis. Works in collaboration with Chief Financial Officer, consultants Vice President of Finance, Director and Managed Care Specialists to recommend contracting strategies, perform complex contract modeling, and to monitor health plan performance. Acts as a liaison between Managed Care Contracting, Reimbursement, Patient Financial Services, Patient Access and other departments in the hospital in an effort to create seamless operational performance and reimbursement maximization related to managed care contracting and performance monitoring. Department Description: Serving the community since 1961, WakeMed Health & Hospitals is the leading provider of health services in Wake County. With a mission to improve...

Overview: Oversees the data gathering, financial modeling and creation of ad hoc financial reports using multiple database systems for the Managed Care department. The financial models and reports are used for contract negotiations, auditing purposes, and validating claim payments to help assist senior level leadership in the decision-making process. The role is also responsible for maintaining and auditing the current financial models in the finance database system for accurate reporting, and investigating over and under payments for claims variances and participating in various department related special projects Department Description: Serving the community since 1961, WakeMed Health & Hospitals is the leading provider of health services in Wake County. With a mission to improve the health and well-being of our community, we are committed to providing outstanding and compassionate care. For more information, visit  www.wakemed.org . EOE Licensure: Not Applicable...