Position Purpose:

The Managed Care Representative is responsible for assisting patients with authorization and referral issues to insure proper billing of claims. The Managed Care Coordinator will review individual insurance policies to ensure billing requirements are being met, provide follow-up on any concerns, determine and obtain necessary authorizations from payers and update accounts as necessary. Key areas include but are not limited to checking eligibility, answer inquiries from patients and clinic staff, handling referrals and authorizations. The Managed Care Coordinator will utilize expert problem-solving skills to resolve complex problems, taking all steps necessary to ensure full resolution of issues.

Primary Duties/Responsibilities:

• Determines eligibility for managed care patients including but not limited to HMO plans, Medicare – Medicaid Alignment Initiative plans and Medicaid of Illinois Integrated Care Program plans.
• Ensures authorizations for patient’s managed care plan are obtained in accordance with payer’s policy and required WEC services.
• Verify insurance.
• Register patient in EPIC.
• Enter referral information and scan into EPIC.
• Coordinate appointment.
• Handles all managed care-related patient inquiries, problems and concerns in accordance with clinic objectives and goals.
• Promptly follows up with payers on authorization requests to ensure charges go out in a timely manner for payment.
• Assists Managed Care Coordinator with procedure and laser workques
• Serves as backup to Managed Care Coordinator during time off.
• Works with clinic providers and staff to ensure proper procedures are being met.
• Handles all other duties as assigned by Manager/Supervisor.
• Attends all department meetings as required.
• Follows all HIPAA and Wheaton Eye guidelines regarding patient privacy.

Position Requirements:

Education: Degree/Diploma Required - HS Diploma

Experience:

• High school diploma or equivalent.
• 1 to 3 years experience preferred.
• Knowledge of computers, data entry, spreadsheets, e-mail;
• Strong analytical and troubleshooting skills;
• Outstanding telephone communication and customer service skills;
• Basic knowledge of medical terminology.

Competitive wage rate and benefit package including a generous 401(k) program

EOE