Managed Care Liaison, Senior

Ann & Robert H. Lurie Children’s Hospital of Chicago provides superior pediatric care in a setting that offers the latest benefits and innovations in medical technology, research and family-friendly design. As the largest pediatric provider in the region with a 140-year legacy of excellence, kids and their families are at the center of all we do. Ann & Robert H. Lurie Children’s Hospital of Chicago is ranked in all 10 specialties by the U.S. News & World Report.

Location

Ann & Robert H. Lurie Children's Hospital of Chicago

Job Description

#1 For a Reason:

At Lurie Children's we understand that caring for kids takes more than medicine. From diagnosis through treatment, it requires compassion and understanding that kids do best when they get to be kids. With a team of world-renowned pediatric experts and kid-friendly care, there’s a reason we’re ranked the #1 children’s hospital in Illinois.

Managed Care Liaison, Senior:

Responsible for the day-to-day operations of CIN value-based contracts and developing and maintaining strong relationships with the CIN provider network. The Senior Managed Care Liaison collaborates with the CIN leadership team, payers, Lurie Children’s administrators and subspecialists, and community physicians (and their practice leadership) to achieve departmental and customer service goals. Reporting to the Manager of Network Operations, this role is essential to ensuring compliance with contract requirements, supporting CIN network operations, and leading business development.

Essential Job Functions:

• Serves as the primary contact for CIN providers, acting as a liaison between physicians and payers for investigation and resolution of billing issues, network management (i.e., provider rosters), and tracking/distribution of fee schedules.
• Assist in value-based contract negotiations through financial analysis and contracted rate reviews; facilitate discussions around analysis and implementation of, contracts based on existing in-network agreements; proactively identify out-of-network opportunities.
• Conduct ad hoc analyses as requested by senior leadership related to contract financial data, market assessments, and demographic trends.
• Manages the CIN network and payer rosters including auditing enrollment files and provider attribution, and reconciling monthly contract revenue in accordance with CIN contracts; maintain provider hierarchy in data aggregation tool to support correct attribution of lives
• Develop and consistently update tools for both marketing the value of CIN participation as well as communication with CIN physician members.
• Cultivate effective working relationships with cross-functional departments such as Finance, Legal, Physician Services, Medical Staff Office, Revenue Cycle and Finance
• Responsible for onboarding new practices, updating and maintaining the CIN provider database, ensuring completion of required documentation for new practices, and maintaining the integrity of the rosters for payer contracts.
• Collaborate with provider practices and credentialing organizations at Lurie Children’s Medical Group, CCPA, and Lurie Children’s Hospital to ensure that providers are credentialed in accordance with policies and procedures.

Minimum Qualifications:

• Bachelors degree required, masters degree preferred.
• Minimum of 4 years’ experience in health care environment, with experience in value-based care or managed care.
• Understanding of health insurance operations highly preferred.
• Excellent closed-loop communication with the ability to consistently maintain efficient follow up with necessary stakeholders regarding ongoing and outstanding subjects.
• Strong interpersonal skills with the ability to effectively collaborate with physicians, administrators, and external stakeholders; ability to understand and convey key points related to value-based care models.
• Demonstrated ability to successfully handle multiple projects simultaneously to meet strict deadlines.
• Demonstrated competency and accuracy working with spreadsheets, database, and mainframe applications.
• Ability to take initiative by identifying problems, conceptualizing solutions to the problems, and implementing change at all levels throughout the organization. 
• Ability to work independently as well as collaboratively with people from all levels of the organization. Self-directed in developing new knowledge and skills.
• Proficient in the use of MS Office Applications with emphasis on Excel and spreadsheet management.
• Ability to work remotely