- Responsible for entering payer contracts/rates for the practices into practice management system.
- Maintains and coordinates updates from payers to contract fee schedules within the Practice Management System.
- Audits managed care contracting rates and terms in management system ensuring rates are accurate and complete to contract.
- Provides contract summary sheets to revenue cycle staff regarding health plan limitations and restrictions.
- Monitors and communicates contract changes to revenue cycle staff. Answers routine and general contract term questions.
- Monthly, produces managed care paid claims reports. Reviews reports and verifies that paid claims are in compliance with contracted rates.
- Contacts third party payers to resolve issues and submits appeal in order to obtain outstanding payments.
- Tracks payer denial trends and notifies management of significant changes.
- Updates and maintains current provider licensure files for contracted physicians, practitioners, and nurses.
- Completes state medical license applications and payments to appropriate agencies ensuring applications are accurate, complete, and filed timely.
- Follows-up with state medical licensure boards on status of license applications.
- Notifies providers of any licensure expirations.
- Maintains contracting metrics and runs appropriate reports to obtain statistics.
- Drafts presentations and materials for contracting meetings.
- Other duties as requested or assigned.
- High school diploma or equivalent required.
- Minimum of four (4) years combined medical billing and payment experience required.
- Medical coding experience required.
- Proficiency with computer systems and MicroSoft Office (Word, Power Point, and Excel) required.
- Working knowledgeable of state, federal, and third party claims processing required
- Must successfully complete required e-learning courses within 90 days of occupying position.
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Managed Care Coordinator - Evansville, United States - Regional Business Office
Description
Overview:
Employment Type: Full Time
In-Office Position
Benefits: M/D/V, Life Ins., 401(k), PTO, Paid Holidays
Evansville, IN
JOB SCOPE: Under general supervision, provides administrative support to managed care function by auditing and maintaining managed care contract requirements in computer system, running standard reports, resolving contract errors, and answering routine contract questions. Processes provider credentialing and licensure applications ensuring all licensures are current. Supports and adheres to The US Oncology Compliance Program, to include the Code of Ethics and Business Standards, and The US Oncology's Shared Values.
The US Oncology Network is a thriving organization that fosters forward-thinking, advancement opportunities, and an inspired work environment. We continuously look for top talent who will continue to propel our organization in the right direction and celebrate new successes Come join our team in the fight against cancer
About US Oncology
The US Oncology Network is one of the nations largest networks of community-based oncology physicians dedicated to advancing cancer care in America. The US Oncology Network is supported by McKesson Corporation focused on empowering a vibrant and sustainable community patient care delivery system to advance the science, technology, and quality of care. For more information, visit We extend an extremely competitive offering of benefits to employees, including Medical Health Care, Dental Care, Vision Plan, 401-K with a matching component, Life Insurance, Short-term and Long-term disability, and Wellness & Perks Programs.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
MINIMUM QUALIFICATIONS:
PHYSICAL DEMANDS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is required to be present at the employee site during regularly scheduled business hours and regularly required to sit or stand and talk or hear. Requires full range of body motion including handling and lifting patients, manual and finger dexterity, and eye-hand coordination. Requires standing and walking for extensive periods of time. Occasionally lifts and carries items weighing up to 40 lbs. Requires corrected vision and hearing to normal range.
WORK ENVIRONMENT: The work environment may include exposure to communicable diseases, toxic substances, ionizing radiation, medical preparations and other conditions common to an oncology/hematology clinic environment. Work will involve in-person interaction with co-workers and management and/or clients. Work may require minimal travel by automobile to office sites.
