MedPro Managed Care Specialist

Description

JOB SUMMARY

Under the direction of the Revenue Integration Manager, the Managed Specialist is responsible for obtaining preauthorization for inpatient admissions, outpatient surgeries and advanced imaging procedures; and for charge processing through various methods to facilitate the billing process. 

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Managed Care
• Utilize the Managed Care Worklist to track receipt, delays and completion of requests, to prioritize requests and obtain authorizations at minimum one week prior to scheduled date of service, as possible.
• Communicate in a professional manner with staff in medical offices and co-workers.
• Be knowledgeable of current insurance carrier requirements regarding pre-authorization of services and update/maintain the Preauthorization Insurance Matrix at minimum on an annual basis.
• Stay current on insurance carrier requirements for pre-authorizations through continuing education opportunities and research.
• Assist medical offices with questions.
• Analyze data recorded in the Managed Care Work list to provide recommendations for process improvements.
• Utilize the Managed Care Worklist to provide feedback to Practice Managers on authorization requests that could not be processed by MedPro for various reasons (i.e. missing information, auth not required per matrix, etc).
• Charge Processing
• Registration and updating of patients records from information received from the provider’s office- maintaining a high level of accuracy.
• Review charge entry documents for complete information in preparation for keying.
• Post charge transactions using Context claim scrubber or process charge files through the PARC application, maintaining a high level of accuracy.
• Follow all balancing procedures and complete forms promptly and correctly.
• Notify leader if charges received cannot be released within contract standard time period.
• Maintain checklist for the registration and charge entry processes for each customer.
• Research and resolve missing charge issues for assigned customers within timeframes established by Manager.
• Maintain an understanding of the impact on the remainder of the billing process and work with leadership on continued process improvements and efficiencies.
• Accurately follows written and verbal instructions.
• Other duties as assigned by management are accepted willingly and completed in a timely manner.

CORPORATE CULTURE RESPONSIBILITIES

• Follow established corporate and department-specific policies and procedures.
• Attend all corporate and department-specific required training.
• Uphold MCC’s Purpose, Values, and Vision.
• Abide by MCC’s Corporate Culture Responsibilities.
• Perform other duties as may be assigned cheerfully and willingly.

Requirements

EDUCATION/EXPERIENCE REQUIREMENTS

• Minimum education requirement is high school diploma, or equivalent.
• Medical billing/insurance experience.

KNOWLEDGE, SKILLS AND ABILITIES

• Ability to prioritize and manage multiple tasks.
• Displays customer services skills, strong interpersonal skills, close attention to detail, excellent verbal and written communication skills, and basic math skills.  Good organizational skills and ability to adapt to frequent changes.
• Be a person of integrity and character, willing to embrace change and make a positive impact in the lives of patients and co-workers.
• Ability to work with staff members at all levels of the organization in a cooperative, team-oriented manner.
• Displays computer proficiency (i.e. PC Windows, MS Office) and ability to quickly learn new applications. 
• Proficient in use of English language both in written and verbal communication.
• Must be able to communicate with individuals of varying socio-economic backgrounds.
• General overall understanding of other MedPro services department functions. 
• Good understanding of complete charge cycle, including charge entry, all aspects of insurance billing and collections and the self-pay process.
• Must be committed to the protection of confidential information, records and/or reports.
• Possess strong critical thinking and analytical skills.
• Proficient in use of the following computer / software applications: PPP, Horizon System, Microsoft Excel and Word. 

PHYSICAL REQUIREMENTS OF THE ESSENTIAL JOB FUNCTIONS

• Strength (Lift/Carry/Push/Pull): Sedentary (exerting up to 10 pounds of force occasionally)
• Standing/Walking: Occasionally; activity exists up to 1/3 of the time
• Keyboarding/Dexterity: Frequently; activity exists from ¾ of the time
• Ability to look at a computer screen for extended periods.
• Ability to perform constant repetitive hands and finger motions.
• Ability to maintain focus while working in close proximity to others.
• Talking (Must be able to effectively communicate verbally): Yes
• Seeing: Yes
• Hearing: Yes

EMOTIONAL REQUIREMENTS OF THE ESSENTIAL JOB FUNCTIONS

• Must exhibit stable work behaviors daily.
• Must possess adequate individual coping skills.
• Ability to remain calm and professional regardless of workload or time constraints.  
• Must be able to work under stress and remain calm and professional.   

WORK ENVIRONMENT  

• Office environment
• Exposed to frequent and constant interruptions in daily functions/schedule. 
• May be required to work extended hours to meet department needs