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Jobs · OTHR · North Carolina

Managed Care Representative I

Physicians East · Greenville, NC · Yesterday
On-siteOTHRFull-time

Physicians East, P.A. is a team of skilled healthcare professionals united to deliver quality, cost-efficient, comprehensive healthcare to the people of Eastern North Carolina.

Location & Commitments

Full-time role based at Greenville OB/GYN, Monday–Friday, 8 a.m.–5 p.m. Additional hours may be required to meet business needs. Weekend work is rare but can occasionally be necessary.

About the Role

The Managed Care Representative I is responsible for maintaining incoming and outgoing authorizations and referrals for multiple departments and specialties within Physicians East. Duties include reviewing Request for Authorization forms, verifying insurance coverage, contacting insurance companies to confirm benefits and authorization requirements, recording and submitting authorization details, and documenting denials.

Responsibilities

  • Maintain and process incoming and outgoing authorizations for assigned department(s) and assist with STAT authorizations for team members during absences.
  • Communicate with providers and clinical teams when orders are missing or additional information is needed for authorization.
  • Research “Non-authorized” denials and obtain retroactive authorizations when applicable.
  • Notify scheduling teams when procedures have not been preauthorized.
  • Provide inter-departmental authorizations and internal referrals.
  • Obtain prior approval authorizations for specialists performing tests or procedures (clinical staff or scheduling personnel notify the Managed Care Representative when procedures or outside testing is needed).
  • Obtain in-patient authorization or precertification for hospital admissions.
  • Notify appropriate personnel of any insurance-required changes.
  • Route applicable procedures to the Cost Estimates team.
  • Provide coverage for managed care co-workers during vacation, sickness, or leave of absence.

Requirements

  • High School Diploma (required); Associate Degree (preferred).
  • Experience in a medical office environment and knowledge of Medical Terminology (required).
  • Strong computer skills.
  • Minimum of one year of patient/public contact experience.
  • Minimum of one year of Managed Care Insurance experience (preferred).
  • Strong sense of team commitment, including meeting deadlines, punctuality, and excellent follow-through.
  • High level of confidentiality, integrity, and initiative.
  • Ability to form positive and collaborative relationships with peers and physicians at all levels.
  • Exceptional interpersonal communication skills to create a favorable impression for the organization.

Typical Physical Demands

  • Prolonged sitting in an office environment.
  • Some bending and stretching required.
  • Frequent use of telephone, fax machine, copier, calculator, and computer keyboard.
  • Manual dexterity required for equipment operation.
  • Ability to work under stress.

Typical Working Conditions

Work is performed in an office environment with extensive telephone contact with insurance companies, medical facilities, patients, and internal staff.

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