Managed Care Specialist

Overview

• Work as a Managed Care Specialist to resolve denied and underpaid claims efficiently.
• Collaborate with payers and internal teams to address billing discrepancies.
• Utilize your expertise in Medicare, Medicaid, and managed care billing processes.
• Ensure compliance with managed care contracts and payment methodologies.
• Prepare detailed reports and appeals to resolve payment issues.
• Work closely with the Revenue Cycle Director to achieve organizational goals.
• Contribute to the optimization of billing systems and recovery processes.
• Maintain accurate tracking of claims and appeals progress.

Key Responsibilities & Duties

• Analyze managed care contracts to identify discrepancies and resolve disputes.
• Prepare and submit appeals and reconsideration requests to payers.
• Collaborate with MCO payers to resolve payment errors and underpayments.
• Generate monthly reports and track responses from payers.
• Audit claim payments and monitor recovery performance.
• Utilize billing systems to identify and address payment issues.
• Communicate effectively with internal teams and external payers.
• Assist the Revenue Cycle Director in resolving billing challenges.

Job Requirements

• High School Diploma or GED required; Bachelor's Degree preferred.
• Minimum of 5 years of experience in health insurance and skilled nursing billing.
• Proficiency in Medicare, Medicaid, and managed care billing processes.
• Strong knowledge of billing systems and provider portals.
• Expertise in managed care contracts and payment methodologies.
• Advanced skills in Excel and patient accounting systems.
• Excellent communication and organizational skills.
• Ability to work independently and meet deadlines effectively.