Customer Service Representative

Managed Care Specialist

The Managed Care Specialist will:

• Serve as a contact for all managed care related issues in the Pediatric Subspecialty unit.
• Keep the Managed Care information up-to-date for all physicians and providers for all subspecialty practices and locations in practice at location and distributes updates to all employees.
• Responsible for maintaining and identifying the following:
• Credentialed physicians and individual or group ID numbers
• Provider Relations Numbers and Utilization Management numbers
• Referral policies
• Appropriate laboratory and radiology sites
• Process for ER services
• Responsible for all referrals and pre-authorizations that need to be generated with the patient population, across Subspecialty Pediatric.
• Complete the appropriate referral form for each insurer and receiving specialty.
• Process referrals within 24 hours of physician request.
• Respond promptly to those patients in physician offices needing immediate referrals.
• Track referrals that are "in process" with utilization management/preauthorization. Ensures that all referrals are completed.
• Coordinate appeal efforts with each physician, as necessary.
• Work with ancillary departments at the Hospital to ensure they have proper information when registering patients.
• Document all efforts so that they can be traced.
• Remain current in topics of coding.
• Update knowledge of Current Procedural Terminology and the ICD.
• Assist with other duties including the payables in the department of pediatrics.
• Organize and maintain daily records related to payables across all cost centers
• Prepare and maintain sub-code tracking spreadsheet for all payables in the department.
• Prepare all travel and reimbursement vouchers.
• Work in conjunction with practice administrator to research and correct any issues related to reimbursements or payables.
• Maintain tracking spreadsheets for various accounts, Research, Practice and Foundation Accounts.
• Organize and maintain data for each department cost centers in excel and or other database.
• Maintain department physical files for credentialing and payables.
• Print and maintain department reports in physical format.
• Assist in various clinical and administrative areas as rotating support coverage for phones, scheduling and registration as needed.

Requirements:

• Good reading, mathematic, basic accounting, comprehension skills.
• High attention to detail.
• Familiarity with generally accepted coding standards with at least two (2) years of experience directly related to medical billing and coding.
• Must have the motivation to pursue aggressive follow-up activities consistently, as necessary.
• Superior organizational and prioritization skills.
• Professional interpersonal skills necessary to communicate effectively with patients, staff, physicians, and outside companies.

We offer competitive base rates that are determined by many factors, including job-related work experience, internal equity, and industry-specific market data. In addition to base salary, some positions may be eligible for clinical certification pay and shift differentials. The salary range listed for exempt positions reflects full-time compensation and will be prorated based on employment status. Saint Peter's offers a robust benefits program to eligible employees that will support you and your family in working toward achieving and maintaining secure, healthy lives now and into the future. Benefits include medical, dental, and vision insurance; savings accounts, voluntary benefits, wellness programs and discounts, paid life insurance, generous 401(k) match, adoption assistance, back-up daycare, free onsite parking, and recognition rewards. You can take your career to the next level by participating in either a fully paid tuition program or our generous tuition assistance program. Learn more about our benefits by visiting our site at Saint Peter's.