Job Description Help for Job Description. Opens a new window.

JOB SUMMARY

Under the direction of the Revenue Integration Manager, the Managed Specialist is responsible for obtaining preauthorization for inpatient admissions, outpatient surgeries and advanced imaging procedures; and for charge processing through various methods to facilitate the billing process.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Managed Care
• Utilize the Managed Care Worklist to track receipt, delays and completion of requests, to prioritize requests and obtain authorizations prior to scheduled date of service, as required by protocol.
• Communicate in a professional manner with staff in medical offices and co-workers.
• Be knowledgeable of current insurance carrier requirements regarding pre-authorization of services and update/maintain the Preauthorization Insurance Matrix at minimum on an annual basis.
• Stay current on insurance carrier requirements for pre-authorizations through continuing education opportunities and research.
• Assist medical offices with questions.
• Analyze data recorded in the Managed Care Work list to provide recommendations for process improvements.
• Utilize the Managed Care Worklist to provide feedback to Practice Managers on authorization requests that could not be processed by MedPro for various reasons (i.e.missing information, auth not required per matrix, etc.) by providing to manager.
• Maintain an understanding of the impact on the remainder of the billing process and work with leadership on continued process improvements and efficiencies.
• Accurately follows written and verbal instructions.
• Other duties as assigned by management are accepted willingly and completed in a timely manner.

CORPORATE CULTURE RESPONSIBILITIES

• Follow established corporate and department-specific policies and procedures.
• Attend all corporate and department-specific required training.
• Uphold MCC's Purpose, Values, and Vision.
• Abide by MCC's Corporate Culture Responsibilities.
• Perform other duties as may be assigned cheerfully and willingly.