Managed Care Coordinator

Job Description

Job Description

Description:

Carolina Neurosurgery and Spine Associates is seeking a PRN Managed Care Coordinator for our Charlotte office.

Job Objective : To maximize practice revenue by working effectively and efficiently with others to meet monthly RCM goals. Promotes positivity and collaboration within all CNSA departments.

Essential Job Responsibilities:

• Obtains authorization for procedures as applicable to the patient’s insurance in a timely manner and based on urgency
• Works denials for unapproved pre-authorizations; follows up with insurance company to verify approval
• Works closely with Coding Department to ensure proper codes are authorized
• Communicates in an appropriate, professional manner with insurance associates, other CNSA staff, and patients or patient’s family members/contacts
• Updates database with authorization and managed care data
• Informs manager of critical situations concerning insurance plans
• Provides assistance to co-workers/satellite offices with education, problems, and questions concerning insurance and the authorization process
• Maintains strictest confidentiality and follows all CNSA guidelines regarding HIPAA regulations
• Performs at least minimum number of required tasks as assigned by management
• Completes additional tasks as assigned by management

This posting is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities of this position. CNSA retains the discretion to add to or change the job responsibilities of any position at any time with or without notice.

Company Culture Responsibilities:

• Reflects CNSA Core Values in all job responsibilities and interactions
• Compassion: Treats others with compassion and empathy
• Teamwork: Collaborates with all team members
• Communication: Communicates effectively and with positivity
• Integrity: Acts with integrity and accountability
• Innovation: Remains open-minded to new ideas and continual improvement
• Community: Treats every patient and team member as a part of the CNSA community
• Participates in department or system wide improvement plans
• Reports to work and adheres to assigned schedule from manager
• Performs high-quality work that is neat, accurate, complete, and on time
• Offers help to all patients by promptly responding to requests and needs
• Asks questions to gain full understanding of assignments
• Uses computer for approved work purposes only, and limits personal phone calls

Education: At least a High School Diploma or GED. Post-secondary education in any field is desirable.

Job Related Experience: Minimum one year of pre-certification experience in a health care organization

Other Requirements:

Performance Requirements:

Knowledge:

1. Medical and insurance terminology
2. Payer guidelines
3. Legal and ethical considerations related to patient information
4. HIPAA guidelines and policies
5. Awareness and understanding of interdepartmental responsibilities for informed decision making

Skills:

1. Time management, problem solving, multitasking, and prioritizing
2. Effective communication
3. Basic understanding of Microsoft Office Suite and Electronic Medical Record (EMR) systems
4. Detail orientation

Abilities:

1. Establishes and maintains effective working relationships with coworkers and diverse patient populations
2. Analyzes situations and responds appropriately
3. Organizes and prioritizes information and assignments
4. Works independently with little or no supervision

Working Environment: Office-based with half time spent working in various computer systems and half communicating via phone.

Mental/Physical Requirements: Sitting and standing associated with a typical office environment. Speaking and hearing, both in-person and on the phone.