Managed Care Specialist Bilingual
Job description
Saint Peter's Family Health Center is seeking a Managed Care Specialist to join the Adult Ambulatory Care Services, Internal Medicine How Lane!
Coordinates the presence of managed care with the patient population within the outpatient areas of the department. Designs processes to ensure that authorizations are done accurately and promptly. Provides information to the clinical and support staff with regard to HMO requirements.
Serves as a contact for all managed care related issues in the Pediatric Subspecialty unit.
Keeps the Managed Care information up-to-date for all physicians and providers for all subspecialty practices and locations in practice at location and distributes updates to all employees.
Responsible for maintaining and identifying the following:
- Credentialed physicians and individual or group ID numbers
- Provider Relations Numbers and Utilization Management numbers
- Referral policies
- Appropriate laboratory and radiology sites
- Process for ER services
- Completes the appropriate referral form for each insurer and receiving specialty.
- Processes referrals within 24 hours of physician request.
- Responds promptly to those patients in physician offices needing immediate referrals.
- Tracks referrals that are “in process” with utilization management/preauthorization. Ensures that all referrals are completed.
- Coordinates appeal efforts with each physician, as necessary.
- Works with ancillary departments at the Hospital to ensure they have proper information when registering patients.
- Documents all efforts so that they can be traced.
- Remains current in topics of coding.
- Updates knowledge of Current Procedural Terminology and the ICD.
- Organizes and maintains daily records related to payables across all cost centers
- Prepares and maintains sub-code tracking spreadsheet for all payables in the department.
- Prepares all travel and reimbursement vouchers.
- Works in conjunction with practice administrator to research and correct any issues related to reimbursements or payables.
- Maintains tracking spreadsheets for various accounts, Research, Practice and Foundation Accounts.
- Organizes and maintains data for each department cost centers in excel and or other database.
- Prints and maintains department reports in physical format.
- Assist in various clinical and administrative areas as rotating support coverage for phones, scheduling and registration as needed.
Requirements:
- Good reading, mathematic, basic accounting, comprehension skills.
- High attention to detail.
- Familiarity with generally accepted coding standards with at least two (2) years of experience directly related to medical billing and coding.
- Must have the motivation to pursue aggressive follow-up activities consistently, as necessary.
- Superior organizational and prioritization skills.
- Professional interpersonal skills necessary to communicate effectively with patients, staff, physicians, and outside companies.
Pay Grade 112
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