Managed Care & Billing Program Manager (DOH/OFM #15567)

$36.09 - $57.75 Hourly

$75,072 - $120,115 Annually

This position is a Pay Band 85

Posting Details

This position is part of the Facilities Division team and works closely with Facilities Division Leadership and financial revenue for billing and collections for the seven (7) healthcare facilities (FBMC, NMVH, TLT, NMRC, SATC, NMBHI, LLCP). The position will be a centralized resource to optimize opportunities for Managed Care Organization (MCO) contracts and other service billings and collections. The position will negotiate and manage the MCO contracts and reports to the DOH Facilities Fiscal Officer.
Specifically, initiation of this change will provide the ability to increase health facilities revenues.

Why does the job exist?

The position will manage the billings and collections program, by way of working directly with each facilities finance staff (7 - finance directors, 18 - finance staff) across the state to train, instruct, assess, and verify appropriate billing opportunities and adherence to executed Managed Care Organization (MCO) contracts.

How does it get done?

- Convene necessary stakeholders in DOH to review MCO contracts and obtain feedback from PHD and all facilities
- Serve as the point person to collect necessary documents that MCOs need from OFM as part of the contracting process (ex. W-9s)
- Collaborate with PHD as needed to ensure they are appropriately represented as it pertains to MCO contracting efforts
-Maximize incentives earned in all programs and partner with facilities to identify areas of improvement
-Work with MCOs to get contracted to participate in additional Value Based Care programs
-Discuss any operational issues that the facilities are experiencing with a given MCO
-Troubleshoot any claims-related issues
-Provide oversight to billing teams (i.e. claim resubmissions, sharing of best practices across facilities, etc.)
-Monitor top claim denial reasons with each MCO and troubleshoot
-Paying claims timely
-Ensuring that MCOs are paying interest on claims appropriately & consistently

Who are the customers?

This position is part of the Facilities Division team and works closely with Facilities Division Leadership.

Ideal Candidate

The Ideal Candidate will have experience:

- Working with financial revenue and billing.
- Experience negotiating and manage MCO contracts and reports.

Minimum Qualification

A Bachelor's Degree in any field of study from an accredited college or university and eight (8) years of professional level experience with a light strategic impact directly related to the purpose of the position defined by the agency at the time of recruitment. Substitutions Apply. See Substitution Table below. A hiring agency will designate a portion of the required experience to include management, supervisory and/or specialized experience. Any required licensure, certification or registration shall be defined at the time of recruitment and will be in addition to the above requirements.

Substitution Table

These combinations of education and experience qualify you for the position:
Education Experience 1 High School Diploma or Equivalent AND 12 years of experience 2 Associate's degree AND 10 years of experience 3 Bachelor's degree AND 8 years of experience 4 Master's degree AND 6 years of experience 5 PhD degree AND 4 years of experience
• Education and years of experience must be related to the purpose of the position.

• If Minimum Qualification requires a specific number of "semester hours" in a field (e.g. 6 semester hours in Accounting), applicants MUST have those semester hours in order to meet the minimum qualifications. No substitutions apply for semester hours.

Employment Requirements

Must possess and maintain a valid Driver's License.

Working Conditions

Work is performed in an office setting with exposure to Visual/Video Display Terminal (VDT) and extensive personal computer and phone usage.

Supplemental Information

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Agency Contact Information: George Morgan (505) 660-0350. Email

For information on Statutory Requirements for this position, click the Classification Description link on the job advertisement.

Bargaining Unit Position

This position is not covered by a collective bargaining agreement.