Managed Care Specialist, UPMC Blair Medical Associates

About the role

UPMC Altoona Regional Health Services is looking for a full time Managed Care Specialist to join their dedicated team at Altoona Station Medical Center. The Managed Care Specialist answers all incoming phone calls in the test scheduling area and schedules all testing requested by physician within the group practice for test orders. Coordinates patient care in accordance with required pre-certification.

Responsibilities

• Fax requests and letters to provider or facility performing test/procedure.
• Obtain testing prior authorizations and insurance authorizations for patients
• Understands roster management and is able to assist with it as assigned
• Takes incoming calls and relays messages appropriately.
• Insures timely flow of information regarding managed care contacts and/or patients to specialist, primary care physicians, staff and patients.
• Gives patients complete information regarding any test or procedures being performed, including any preparation requirements.
• Schedules diagnostic testing or procedures outside of for patients.
• Pre-certifies patient services and obtains necessary approval of specialties, hospital admissions, emergency treatment, out of office testing, rehabilitation, DME, and any other necessary service.
• Applies principles of specific managed care product to each task to insure contractual compliance.
• Updates patient chart with scheduled appointment date and time, prep, prints instructions if any.
• Informs HIS Department if any information needs to be sent to consulting physician office.
• Works with manager to maintain files, coordinates patient care as it relates to quality assurance and utilization review.
• Responds to documents and orders from physicians regarding the ordering of tests, procedures and appointment with specialist per physician orders.
• Keeps current with managed care products and how changes may affect.

Requirements

• Graduate of an accredited Medical Secretarial school, accredited Medical Administrative assistant program, accredited Medical Assistant program or LPN program (valid state license) or one year vocational technical school; minimum six months related experience and/or training; or equivalent combination of education and experience.
• Medical terminology required.
• Act 34 clearance with renewal.

Benefits

UPMC offers a generous benefits package, an expansive total rewards package, opportunity to grow your career and much more.

Schedule

This role will work daylight shifts, Monday through Friday.