Health Insurance Verification Jobs in Baltimore, MD

Reports to:  Regional Directors of Network Contracting & Payor Relations

FLSA Status: Non-Exempt

*This position does not meet the criteria for exemption from the provisions of the Fair Labor Standards Act; thus, you will be eligible to receive overtime compensation, as appropriate. Overtime requires prior approval from your supervisor. 

Under minimal supervision, assists the Contracting and Payor Relations team, the Reimbursement Operations team and the authorization team in a support role handling departmental projects as assigned, facilitating communications to and from insurance companies, and internal/external contacts regarding updates on physician staff and facility information. Provides updates on contracts, special agreements, reimbursement resolution, and other pertinent information. Performs complex administrative support for managed care office operations, payor projects, meeting preparation and special assignments.

• Coordinates with the Regional Directors of Contracting & Payor Relations for the East Coast Managed Care team and provides tracking, implementation, and monitoring of all managed care agreements and facility updates.
• Support contract coordination by researching, analyzing contract data, and facilitating communication between Directors of Contracting and insurance payers ensuring adherence to regulations and payer requirements 
• Manages and coordinates provider agreements and documentation, and ensures the recording and storage in the Managed Care contracting share drive.
• Assists Managed Care Team in operationalizing contracts for practices by following contracting workflow processes and distributing updates and alerts as required.
• Review special bill and single case agreements for content, format, and structure to ensure they are set up for review and approval by the Regional Directors of Contracting.
• Assist with entering data into smart sheets to ensure that ins codes are created and contracts are loaded into NPD.
• Serve as the liaison with outside contracting representatives
• Assists departments in maintaining accurate databases of contracts and fee schedules in the National Payor Database (NPD).
• Organizes and maintains a catalog of monthly payor correspondence regarding new plan/product offerings, fee schedule and/or policy changes.
• Works collaboratively with the Regional Directors of Contracting, Operations and Credentialing departments to maintain/update the RadNet East Coast Facility List, (sometimes referred to as the “Source of Truth” draft/distribute the corresponding payor notifications, document correspondent received from the payer and performs follow up to ensure the updates have been completed in the payor systems.
• Builds relationships and maintains system of internal communications within RadNet to work collaboratively with NPD Admins, Contract Compliance Revenue Analysts, Insurance Verification,

Credentialing, Information Technology, Systems, Clinical Operations, Marketing & Sales, Revenue Cycle Operations teams and Legal department.

• Maintains a grid of payor contact information and builds relationships with payor counterparts.
• Coordinates with the Directors of Contracting - scheduling of internal/external meetings, conference calls, and other events.
• Drafts confidential correspondence, edits documents, and coordinates other administrative duties such as internal/external mail, emails, voicemails, faxes, copying, and filing.
• Assists Regional Director of Contracting with communications with sales team to collect and/or provide annual demographic changes and updates to payor networks upon approval by the Regional Directors of Contracting. Completes special managed care projects; performs independent research and prepares/gathers information for reports and data summaries.
• Assists other departments with projects as needed in the spirit of teamwork.
• Prepares reports on financial performance, reimbursement trends, and payer relationships to support leadership decision-making.
• Supports the negotiation of reimbursement rates and contract terms, typically working under the direction of the Regional Director of Contracting.

PLEASE NOTE:  This is not an exhaustive list of all duties, responsibilities and requirements of the position described above.  Other functions may be assigned and management retains the right to add or change duties at any time.

• Able to exercise a high degree of initiative, judgment, discretion and decision-making to achieve objectives including the ability to handle highly confidential issues.
• Demonstrates a high-level of integrity and a proactive approach to internal and external customer service.
• Working knowledge of computers, including MS Word and Excel and proficiency in Outlook and PowerPoint. Must pass an Excel Assessment with a score of 80% or higher.
• Ability to handle complex assignments under minimal supervision.
• Excellent interpersonal skills with the ability to professionally communicate clearly both written and verbally.
• Ability to be detail-oriented, fully grasping the concept of multi-tasking and constant reprioritization of assigned tasks with a sense of urgency.
• Knowledge of laws, state and national health care industry regulations preferred.
• Must be able to work effectively both independently and with others.
• BS/BA preferred.
• Radiology managed care contracting experience with a background in business preferred.
• The above knowledge, skills and abilities may also be demonstrated by the equivalent prior experience in a health care, payor relations, and/or contracting field.
• One to two years of prior experience supporting an Executive or Senior level Director is mandatory

Quality Standards:

• Able to exercise a high degree of initiative, judgment, discretion and decision-making to achieve objectives including the ability to handle highly confidential issues.
• Demonstrates a high-level of integrity and a proactive approach to internal and external customer service.
• Working knowledge of computers, including MS Word and Excel and proficiency in Outlook and PowerPoint. Must pass an Excel Assessment with a score of 80% or higher.
• Ability to handle complex assignments under minimal supervision.
• Excellent interpersonal skills with the ability to professionally communicate clearly both written and verbally.
• Ability to be detail-oriented, fully grasping the concept of multi-tasking and constant reprioritization of assigned tasks with a sense of urgency.
• Knowledge of laws, state and national health care industry regulations preferred.
• Must be able to work effectively both independently and with others.
• BS/BA preferred.
• Radiology managed care contracting experience with a background in business preferred.
• The above knowledge, skills and abilities may also be demonstrated by the equivalent prior experience in a health care, payor relations, and/or contracting field.
• One -two years of prior experience supporting an Executive or Senior level Director is mandatory

We Offer:

• Comprehensive Medical, Dental and Vision coverages.
• Health Savings Accounts with employer funding.
• Wellness dollars
• 401(k) Employer Match
• Free services at any of our imaging centers for you and your immediate family.

This position often requires sitting, standing, walking, bending, twisting, reaching with hands and arms, using hands and fingers, handling, or feeling, speaking, listening, and high-level cognitive thinking. Also, must be able to lift up to 10 pounds occasionally. The position requires the ability to travel (~10% of time), drive a vehicle, and utilize other forms of transportation.

This position is fully remote requiring a quiet, distraction-free workspace. Must have high-speed internet with a minimum of 50 Mbps download / 10 Mbps upload speed and direct router connection.  Participation in virtual meetings via video (on camera) and audio is required. 

Pay Range $30.00 - $35.00 per hour