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    managed care specialist - Maryville, United States - Blount Memorial Hospital

    Blount Memorial Hospital
    Blount Memorial Hospital Maryville, United States

    2 weeks ago

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    Description


    MANAGED CARE SPECIALIST JOB SUMMARYA Managed Care Specialist reviews all hospital/physician payment variances and prepares and files appeals or otherwise works with payer to ensure full payment according to contract for services provided.

    Identifies trends with third party payers as well as in-house activity that results in payment variances and offers opportunities for process improvement.

    Works closing with Billing/Follow Up, Case Management, and Patient Access.

    MANAGED CARE SPECIALIST JOB SPECIFICATIONSEDUCATION AND/OR EXPERIENCE:
    High school diploma, or GED required; medical terminology and coding courses preferred.

    Requires at least three (3) years experience with third party follow up; two (2) years experience as a Patient Account Rep II, Credit Analyst; one (1) year experience as a Patient Account Rep I; or equivalent experience.

    Experience in hospital/physician billing, Managed Care contracts, customer service, insurance benefit verification and precertification preferred.


    KNOWLEDGE:

    Requires thorough knowledge of insurance company processes and insurance contract reimbursement methodology as well as fundamental understanding of hospital/physician fee schedules and how they apply contractually.

    Requires in depth knowledge of medical coding affecting adjudication of UB-04 claims, including; APC, ICD, CPT, HCPCS, DRG, and revenue code structures.


    SKILLS:
    Requires analytical problem solving skills to organize/assess information based on data collected; Critical thinking, judgment, and decision making skills are essential; Requires excellent computer skills in various information systems; Requires excellent verbal, mathematical, and written communication skills


    ABILITIES:

    Requires an ability to work independently and gain assistance from multiple sources; Requires an ability to integrate information and make decisions; Requires an ability to provide consistent, effective follow-up and documentation; Requires an ability to effectively with departments in a team environment.

    Ability to communicate professionally and thoroughly with staff, patients, insurance companies, business partners and other parties.
    Competitive Pay and BenefitsHealth, dental and vision insuranceRetirement plan with matchingFlexible Savings Account (FSA)Disability insuranceLife InsurancePaid sick timePaid time offPaid trainingReferral programTuition reimbursementEmployee Assistance Program
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