Managed Care Specialist

Serving Managed Care

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.

Responsibilities

• Maintain and identify 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
• Generate and process referrals for each insurer and receiving specialty within 24 hours of physician request.
• Respond promptly to patients in physician offices needing immediate referrals.
• Track referrals that are “in process” with utilization management/preauthorization.
• Ensure 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.

Qualifications

• Good reading, mathematical, basic accounting, comprehension skills.
• A 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.
• 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.

Benefits

• Competitive base rates determined by many factors, including job-related work experience, internal equity, and industry-specific market data.
• Includes clinical certification pay and shift differentials.
• Offers a robust benefits program to eligible employees, including medical, dental, and vision insurance; savings accounts, voluntary benefits, wellness programs and discounts, paid life insurance, generous 401(k) match, adoption assistance, back-up daycare, free onsite parking, and recognition rewards.

Pay

• Salary Range: 17.75 - 24.73 USD

Schedule

• Full-time position.