Manage Care Coordinator Sr.

The US Oncology Network; Tucson (AZ); On-site; USD 45,000 - 60,000; Full time

Job summary

A healthcare network specializing in oncology is seeking an Administrative Support professional to maintain managed care contract requirements, audit documentation, and produce reports. Candidates should have at least two years of managed care and credentialing experience, along with medical billing background. Proficiency in Microsoft Office is essential, and the role requires in-person presence during business hours, involving direct interaction with coworkers and clients. This position offers opportunities for process improvements and monitoring compliance with contract rates.

Qualifications

• Minimum of two years managed care and credentialing experience.
• Four years combined medical billing and payment experience.
• Working knowledgeable of state, federal, and third party claims processing.

Responsibilities

• Provide administrative support to managed care function.
• Enter payer contracts/rates into the management system.
• Produce managed care paid claims reports monthly.

Skills

Managed care experience

Medical coding

Proficiency in Microsoft Office

Attention to detail

Education

High school diploma or equivalent

Associates degree in Finance or Business

Job description

Overview

SCOPE: With minimal supervision, provides administrative support to managed care function by auditing and maintaining managed care contract requirements in computer system, running standard reports, resolving contract errors, and answering routine contract questions. Processes provider credentialing and licensure applications ensuring all licensures are current. Supports and adheres to the US Oncology Compliance Program, to include the Code of Ethics and Business Standards, and US Oncology's Shared Values.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Responsible for entering payer contracts/rates for the practices into practice management system.
• Maintains and coordinates updates from payers to contract fee schedules within the Practice Management System.
• Audits managed care contracting rates and terms in management system ensuring rates are accurate and complete to contract. Provides contract summary sheets to revenue cycle staff regarding health plan limitations and restrictions. Monitors and communicates contract changes to revenue cycle staff. Answers routine and general contract term questions.
• Monthly, produces managed care paid claims reports. Reviews reports and verifies that paid claims are in compliance with contracted rates. Contacts third party payers to resolve issues and submits appeal in order to obtain outstanding payments. Tracks payer denial trends and notifies management of significant changes.
• Updates and maintains current provider licensure files for contracted physicians, practitioners, and nurses. Completes state medical license applications and payments to appropriate agencies ensuring applications are accurate, complete, and filed timely. Follows-up with state medical licensure boards on status of license applications. Notifies providers of any licensure expirations.
• Maintains contracting metrics and runs appropriate reports to obtain statistics. Drafts presentations and materials for contracting meetings.
• Trains new coworkers on policies and procedures. Double checks co-workers work and provides procedure guidance. May research, resolve, or provide direction on co-workers escalated issues.
• Proactively identifies processes and procedures gaps and develops tools to improve efficiencies.
• Other duties as requested or assigned.

MINIMUM QUALIFICATIONS

• High school diploma or equivalent required.
• Associates degree in Finance, Business or four years revenue cycle experience preferred.
• Minimum of two (2) years managed care and credentialing experience as well as four (4) years combined medical billing and payment experience required.
• Medical coding experience required.
• Proficiency with computer systems and MicroSoft Office (Word, Power Point, and Excel) required.
• Working knowledgeable of state, federal, and third party claims processing required.
• Must successfully complete required e-learning courses within 90 days of occupying position.

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is required to be present at the employee site during regularly scheduled business hours and regularly required to sit or stand and talk or hear. Requires full range of body motion including handling and lifting patients, manual and finger dexterity, and eye-hand coordination. Requires standing and walking for extensive periods of time. Occasionally lifts and carries items weighing up to 40 lbs. Requires corrected vision and hearing to normal range.

WORK ENVIRONMENT

The work environment may include exposure to communicable diseases, toxic substances, ionizing radiation, medical preparations and other conditions common to an oncology/hematology clinic environment. Work will involve in-person interaction with co-workers and management and/or clients. Work may require minimal travel by automobile to office sites.