Managed Care Specialist

Overview

Coordinates the managed care paperwork and processes of the assigned clinic(s). Prepares referrals, obtains authorizations and pre-certifications for clinic patients. Assists patients in procuring the most appropriate care based upon their managed care plans. Acts as a primary contact for managed care company personnel. Teaches and communicates new managed care plans/policies to relevant clinic personnel. Embodies the Memorial Health System Performance Excellence Standards of Safety, Courtesy, Quality, and Efficiency that support our mission, vision and values.

USD $20.99/Hr.

USD $32.54/Hr.

• High School diploma required.

• Three - five years physician office practice experience as a receptionist, or other relevant experience required.

• Must possess knowledge of medical terminology.
• Computer experience required.

• Responsible for obtaining necessary referrals for patients in need of ancillary or specialty services. Maintains documentation accordingly and provides authorization codes and numbers to patients. Works directly with patients regarding the requirements and limitations of their health plan.
• Maintains key contacts at managed care companies, documenting all interactions, helping to facilitate managed care process. Maintains managed care notebooks containing requirements, keeping information current. Helps keep other clinic employees informed of requirements of different plans. Acts as a primary contact when change is forthcoming.
• If required, faxes copies of medical records to insurance companies, managed care companies and physicians’ offices to ensure that the patient’s referral will be a covered service, and that the recipient physician is prepared for the visit. Applies the Minimum Necessary Standard when accessing protected health information.
• Assists clinic in meeting goals related to days in accounts receivable by working as part of a team responsible for accurate billing and cash management, including bank deposits.
• Embodies the Memorial Health System Performance Excellence Standards of Safety, Courtesy, Quality, and Efficiency that support our mission, vision and values:
• SAFETY:
  Prevent Harm - I put safety first in everything I do. I take action to ensure the safety of others.
• COURTESY:
  Serve Others - I treat others with dignity and respect. I project a professional image and positive attitude.
• QUALITY:
  Improve Outcomes - I continually advance my knowledge, skills and performance. I work with others to achieve superior results.
• EFFICIENCY:
  Reduce Waste - I use time and resources wisely. I prevent defects and delays.
• Assists clinic in meeting goals related to quality and customer satisfaction by providing outstanding service when offering assistance, guidance, and direction to visitors and patients, in person and over the phone. Makes appointments. Monitors patient flow through reception and works with team to minimize waits and delays.
• Complete FMLA, workers compensation documentation, disability and other patient requested documentation.
• Demonstrates support for and participates in accomplishing team goals and objectives. Completes all other duties as assigned.

The intent of this job description is to provide a representative summary of the major duties and responsibilities performed by incumbents of this job. Incumbents may be requested to perform tasks other than those specifically presented in this description.