TEMPORARY UTILIZATION MANAGEMENT COORDINATOR

Full-time employees will enjoy a competitive benefits package with options for you and your family including:

The compensation and benefits information is accurate as of the date of this posting. The Company reserves the right to modify this information at any time, with or without notice, subject to applicable law.

Equal Opportunity Employer

Are you looking for a career you can feel good about? We hire only those that strive to do their best. By joining our family, you'll receive the honor and recognition that comes with working for the industry's global leader in evidenced based rehabilitation.

Who We Are:

GEO provides complementary, turnkey solutions for numerous government partners worldwide across a spectrum of diversified correctional and community reentry services. From the development of state-of-the-art facilities and the provision of management services and evidence-based rehabilitation to the post-release reintegration and supervision of individuals in the community, GEO offers fully diversified, cost-effective services that deliver enhanced quality and improved outcomes.

Why Work for GEO:

• We believe that work is more than a place you go to every day. It is about being inspired and motivated to achieve extraordinary things.
• Employee benefits play an important role in making The GEO Group a great place to work. At GEO, we believe in the three pillars of employee wellbeing: physical, emotional, and financial. With comprehensive benefits and competitive wages, we trust that you will find all the resources you need here to be successful.

Summary

This position reviews and processes provider contracts and out of network medical claims to ensure the Company meets and exceeds quality and financial goals. It develops strong relationships with facility Health Services Administrators and the medical providers affiliated with the Company's network hospitals to achieve network growth and cost targets. In addition, it works closely with the senior management to investigate, research and report on medical claims.

Primary Duties and Responsibilities

• Serves as a primary contact for providers and act as a liaison between the providers and the Company.
• Receives and effectively responds to external provider related contract and claims issues.
• Coordinates physician network by developing and maintaining relationships to drive business results within a specific geographic area.
• Provides service and education to network physicians or providers.
• Responds to incoming provider inquiries and identifies potential claim trends and follow-ups with provider and facility leadership to ensure that identified problems have been resolved.
• Educates providers regarding policies and procedures related to referrals and claims submission.
• Communicates with both inbound and outbound calls with providers and effectively responds with follow up calls and emails.
• Recruits, generates and coordinates contracts and agreements for physicians, hospitals and ancillary health services groups to establish facility specific health service networks that are competitive with Medicare Pricing Methodology. Ensures administrative support of inpatient and outpatient needs of the medical unit at the institutions.
• Organizes and leads network development projects and ensures the appropriate tactics are used to affect the best possible outcomes.
• Works directly with the Company's Third-Party Claims Administrator in negotiating and building a provider network based on claims received from healthcare providers not currently in network and performs claims research and analysis to provide support for desired savings.
• Requests and monitors weekly Explanation of Benefits (EOB) generated by Third Party Claims Administrators and generates all medical vendor contracts in accordance to contractual terms by and between company and vendor.
• Performs weekly review of facilities accrual logs working closely with Healthcare Finance Manager and facility medical staff identifying and investigating outstanding medical claims.
• Provides ancillary support for facilities in reconciling outstanding medical claims contacting medical providers and hospitals for medical services rendered to inmates, validates eligibility, and executes contracts and single case agreements (SCA) with medical providers not in network.
• Performs other duties as assigned.

Minimum Requirements

• High School Diploma or equivalent.
• One (1) year of professional network provider recruitment and management experience in which negotiating and renegotiating Medicare contracts as required with physicians/physician groups.
• Bi-lingual skills preferred.
• Experience utilizing RBRVS Medicare pricing software.
• Excellent written, verbal, negotiating, and interpersonal skills; be customer-service oriented; can problem solve; be well-organized; and work and perform independently in all negotiations.
• Ability to organize and prioritize under tight deadlines.
• Proven success in dealing effectively with medical professionals at all levels of an organization.
• Ability to work with computers and the necessary software typically used by the department.

The GEO Group, Inc.