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Managed Care Specialist Bilingual

Company

Saint Peter's Healthcare System
Address , New Brunswick, 08901, Nj
Employment type
Salary
Expires 2023-06-24
Posted at 1 year ago
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.

Managed Care Specialist
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:
  • Referral policies
  • Process for ER services
  • Credentialed physicians and individual or group ID numbers
  • Appropriate laboratory and radiology sites
  • Provider Relations Numbers and Utilization Management numbers
Responsible for all referrals and pre-authorizations that need to be generated with the patient population, across Subspecialty Pediatric.
  • Completes the appropriate referral form for each insurer and receiving specialty.
  • Processes referrals within 24 hours of physician request.
  • Works with ancillary departments at the Hospital to ensure they have proper information when registering patients.
  • Responds promptly to those patients in physician offices needing immediate referrals.
  • Remains current in topics of coding.
  • Documents all efforts so that they can be traced.
  • Updates knowledge of Current Procedural Terminology and the ICD.
  • Tracks referrals that are “in process” with utilization management/preauthorization. Ensures that all referrals are completed.
  • Coordinates appeal efforts with each physician, as necessary.
Assists with other duties including the payables in the department of pediatrics.
  • 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.
  • Prepares and maintains sub-code tracking spreadsheet for all payables in the department.
  • Organizes and maintains daily records related to payables across all cost centers
Maintains department physical files for credentialing and payables.
  • 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.
  • Must have the motivation to pursue aggressive follow-up activities consistently, as necessary.
  • Professional interpersonal skills necessary to communicate effectively with patients, staff, physicians, and outside companies.
  • 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.
  • Superior organizational and prioritization skills.

Pay Grade 112