Managed Care Specialist Bilingual

Managed Care Specialist Bilingual
Internal Medicine-How Lane

Saint Peter's Family Health Center is seeking a Managed Care Specialist to join the Adult Ambulatory Care Services, Internal Medicine How Lane!

The Managed Care Specialist Bilingual will:
  • 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.
  • Responsible for maintaining and identifying 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
  • Responsible for all referrals and pre-authorizations that need to be generated with the patient population, across Subspecialty Pediatric.
  • Complete the appropriate referral form for each insurer and receiving specialty.
  • Process referrals within 24 hours of physician request.
  • Respond promptly to those patients in physician offices needing immediate referrals.
  • Track referrals that are "in process" with utilization management/preauthorization. Ensures that 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.
  • Remain current in topics of coding.
  • Update knowledge of Current Procedural Terminology and the ICD.
  • Assist with other duties including the payables in the department of pediatrics.
  • Organize and maintain daily records related to payables across all cost centers
  • Prepare and maintain sub-code tracking spreadsheet for all payables in the department.
  • Prepare all travel and reimbursement vouchers.
  • Work in conjunction with practice administrator to research and correct any issues related to reimbursements or payables.
  • Maintain tracking spreadsheets for various accounts, Research, Practice and Foundation Accounts.
  • Organize and maintain data for each department cost centers in excel and or other database.
  • Maintain department physical files for credentialing and payables.
  • Print and maintain department reports in physical format.
  • Assist in various clinical and administrative areas as rotating support coverage for phones, scheduling and registration as needed.

  • Good reading, mathematic, basic accounting, comprehension skills.
  • 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.
  • Must have 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.

Schedule: Full Time, Monday - Friday, 8:00 or 8:30 am or 9 am shift

Grade 112