Managed Care Specialist Bilingual

Managed Care Specialist Bilingual

Internal Medicine-How Lane

Saint Peter's Family Health Center is seeking a Managed Care Specialist to join the Adult Ambulatory Care Services, Internal Medicine How Lane!

The Managed Care Specialist Bilingual will:

• Serve as a contact for all managed care related issues in the Pediatric Subspecialty unit.

• Keep 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

• Responsible for all referrals and pre-authorizations that need to be generated with the patient population, across Subspecialty Pediatric.

• Complete the appropriate referral form for each insurer and receiving specialty.

• Process referrals within 24 hours of physician request.

• Respond promptly to those patients in physician offices needing immediate referrals.

• Track referrals that are "in process" with utilization management/preauthorization. Ensures that all referrals are completed.

• Coordinate appeal efforts with each physician, as necessary.

• Work with ancillary departments at the Hospital to ensure they have proper information when registering patients.

• Document all efforts so that they can be traced.

• Remain current in topics of coding.

• Update knowledge of Current Procedural Terminology and the ICD.

• Assist with other duties including the payables in the department of pediatrics.

• Organize and maintain daily records related to payables across all cost centers

• Prepare and maintain sub-code tracking spreadsheet for all payables in the department.

• Prepare all travel and reimbursement vouchers.

• Work in conjunction with practice administrator to research and correct any issues related to reimbursements or payables.

• Maintain tracking spreadsheets for various accounts, Research, Practice and Foundation Accounts.

• Organize and maintain data for each department cost centers in excel and or other database.

• Maintain department physical files for credentialing and payables.

• Print and maintain 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.

Schedule: Full Time, Monday - Friday, 8:00 or 8:30 am or 9 am shift

Grade 112