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Managed Care & Payer Relations Supervisor

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Date: May 4, 2021

Location: West Columbia, SC, US, 29169

Company: Lexington Medical Center

Managed Care & Payer Relations 
Full Time 
AM Shift 
40 hours per day

Rated as one of the Top 25 Best Hospitals to Work for in the U.S., the heart of LMC is our 557-bed modern state-of-the-art facility. Winning the prestigious, "Summit Award" from Press Ganey for outstanding patient satisfaction, "Consumer Choice Award" from the National Research Corporation, all contributing to our reputation for giving our patients the highest quality care.  Lexington Medical Center was voted one of South Carolina’s “Best Places to Work” for 2019!

We are located in heart of the Midlands, right outside of Columbia, SC, and one of the most successful integrated healthcare systems in the Southeast. As the third largest employer in the Midlands, we invite you to be a part of our ongoing success and join our LMC Family.

Job Summary

Provides day-to-day leadership to the Payer Reimbursement Representatives. Manages the performance and productivity of the managed care contract compliance system. Ensures accurate and timely identification and recovery of "short pays/underpayments" from contracted & non contracted insurance payers. Identify patterns or recurring trends with payers that consistently do not reimburse in accordance to contracts and communicate this information to the appropriate parties (Manager, Director, Payer Representatives, etc.).

Minimum Qualifications

Minimum Education: High School Diploma or Equivalent
Minimum Years of Experience: 8 Years of experience in managed care finance.
Substitutable Education & Experience: 8 Years of experience can be substituted with a Bachelor's Degree in a business related field and 3 years of experience in managed care finance
Required Certifications/Licensure: None.
Required Training: Ability to manipulate data in spreadsheets in order to report trends/patterns/statuses or abuses to Manager;
Working knowledge of managed care terminology and reimbursement methodologies;
Procedural knowledge of hospital or physician practice accounts receivable management and/or revenue cycle, and billing/coding terminology.

Essential Functions

  • Exercises direct supervision of Payer Reimbursement Representatives. Coordinates workloads and workflows. Interviews, hires and trains new employees. Evaluates and counsels employees on work performance and attendance, recommends merit increases, promotions, and term.
  • Ensures accurate identification and timely recovery of hospital and physician practice underpayments by insurance payers.
  • Maintain a high level of professionalism while aggressively pursuing underpayments by third party payers.
  • Will communicate appropriate data to Manager of Managed Care & Payer Relations for purposes of new contract negotiation or re-negotiation of existing contracts.
  • Will be responsible for creating a follow up system to maintain accountability of underpaid accounts.

Duties & Responsibilities

  • Ensure proper documentation of activity or progress in Facility and Professional billing applications and contract management software to ensure that anyone viewing accounts will be aware of current status.
  • Manipulate data to report monthly recovery status.
  • Monthly reporting of consistent underpay patterns/trends or abuses.
  • Mediate meetings with contracted payer representatives related to trends or patterns of underpayments.
  • Act as a resource for hospital and physician practice staff as it relates to questions/concerns regarding managed care payers.
  • Performs all other duties as assigned by Manager.

We are committed to offering quality, cost-effective benefits choices for our employees and their families:

  • Day ONE medical, dental and life insurance benefits 
  • Health care and dependent care flexible spending accounts (FSAs)
  • Employees are eligible for enrollment into the 403(b) match plan day one.  LHI matches dollar for dollar up to 6%.
  • Employer paid life insurance – equal to 1x salary
  • Employee may elect supplemental life insurance with low cost premiums up to 3x salary 
  • Adoption assistance
  • LHI provides its full-time employees employer paid short-term disability and long-term disability coverage after 90 days of eligible employment
  • Tuition reimbursement
  • Student loan forgiveness

Equal Opportunity Employer
It is the policy of LMC to provide equal opportunity of employment for all individuals, and to remain compliant with applicable state and federal laws and regulations. LMC strives to provide a discrimination-free environment, and to recruit, select, on-board, and employ all employees without regard to race, color, religion, sex, age, disability, national origin, veteran status, or pregnancy, childbirth, or related medical conditions, including but not limited to, lactation. LMC endeavors to upgrade and promote employees from within the hospital where possible and consistent with the employee’s desires and abilities and the hospital’s needs.

Nearest Major Market: Columbia
Nearest Secondary Market: South Carolina