Managed Care Specialist

Overview

• Serve as a Managed Care Specialist, focusing on resolving denied and underpaid claims efficiently and accurately.
• Utilize expertise in Medicare, Medicaid, and Managed Care billing to ensure compliance and optimize reimbursement processes.
• Collaborate with internal and external stakeholders to address payment discrepancies and enhance revenue cycle performance.
• Maintain detailed records and reports to track claims, appeals, and payment resolutions effectively.
• Work onsite in a professional environment, adhering to a structured schedule for optimal productivity.
• Contribute to organizational goals by providing insights and solutions to improve financial outcomes.
• Engage in continuous learning to stay updated on industry standards and billing systems.

Key Responsibilities & Duties

• Analyze managed care contracts to identify discrepancies and opportunities for reimbursement improvement.
• Prepare and submit detailed appeals and reconsideration requests to managed care organizations.
• Collaborate with payers to resolve payment errors and underpayments promptly.
• Track and monitor responses from managed care organizations to ensure timely resolution.
• Utilize advanced Excel skills to generate monthly reports and analyze financial data.
• Work closely with the Revenue Cycle Director to address issues and implement solutions.
• Audit claims and payments to ensure accuracy and compliance with contractual agreements.
• Provide training and support to team members on billing systems and processes.

Job Requirements

• Minimum of 5 years’ experience in health insurance and skilled nursing home billing.
• Proficiency in Medicare, Medicaid, and Managed Care billing and reimbursement processes.
• Strong understanding of managed care contracts and payment methodologies.
• Advanced skills in Excel and patient accounting systems.
• Bachelor's degree in a related field is preferred.
• Excellent communication skills and ability to manage challenging conversations effectively.
• Detail-oriented with strong critical thinking and organizational abilities.
• Ability to work independently and meet deadlines in a fast-paced environment.