Managed Care Specialist

Overview

• The Managed Care Specialist role involves managing third-party billing and collections for Medicare, Medicaid, and Managed Care claims.
• This position is a contract opportunity with a Monday-Friday work schedule.
• Candidates will work on-site and collaborate with internal and external stakeholders.
• The role requires creating project spreadsheets, writing appeals, and submitting reports.
• Understanding managed care contracts and payment methodologies is essential for this position.
• The position involves tracking claim responses and resolving payment discrepancies.
• Candidates will work closely with the Revenue Cycle Director to address issues.
• This role offers an opportunity to contribute to the efficiency of billing processes.

Key Responsibilities & Duties

• Resolve managed care denied and underpaid claims in a timely manner.
• Understand managed care contracts and create project spreadsheets for submission to payers.
• Write reconsideration appeals and communicate with MCOs to resolve disputes.
• Collaborate with MCO payers to address payment errors and underpayments.
• Submit monthly Excel reports and appeals letters to resolve underpayments.
• Track MCO responses and monitor recovery performance.
• Audit claim payments and identify issues affecting accounts receivable.
• Work closely with the Revenue Cycle Director to address and resolve issues.
• Perform other duties as assigned by the Director of Revenue Cycle.

Job Requirements

• Minimum 5 years of experience in health insurance or skilled nursing home billing.
• Understanding of Medicare, Managed Care, Medicaid billing and reimbursement processes.
• Proficiency in billing systems such as Netsmart/MyUnity.
• Strong skills in Excel, patient accounting systems, and provider portals.
• Ability to analyze EOBs, remittance advice, and managed care contracts.
• Excellent communication skills and ability to de-escalate conversations.
• Detail-oriented with strong critical thinking and organizational skills.
• Bachelor's degree in a related field is preferred.
• Ability to work independently, meet deadlines, and troubleshoot effectively.