Blount Memorial Hospital
MANAGED CARE SPECIALIST
This job is now closed
Job Description
- Req#: 7009
- MANAGED CARE SPECIALIST JOB SUMMARY
- A 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 SPECIFICATIONS
-
EDUCATION 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 Benefits
Health, dental and vision insurance
Retirement plan with matching
Flexible Savings Account (FSA)
Disability insurance
Life Insurance
Paid sick time
Paid time off
Paid training
Referral program
Tuition reimbursement
Employee Assistance Program
-
-
About the company
Blount Memorial Hospital has a nine-member board of directors that governs a staff of more than 300 physicians, repesenting medical specialties, a total of 304 licensed beds and more than 2,300 employees serving in nursing, technical, administrative an...
Notice
Talentify is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
Talentify provides reasonable accommodations to qualified applicants with disabilities, including disabled veterans. Request assistance at accessibility@talentify.io or 407-000-0000.
Federal law requires every new hire to complete Form I-9 and present proof of identity and U.S. work eligibility.
An Automated Employment Decision Tool (AEDT) will score your job-related skills and responses. Bias-audit & data-use details: www.talentify.io/bias-audit-report. NYC applicants may request an alternative process or accommodation at aedt@talentify.io or 407-000-0000.