MedPro Managed Care Specialist

West-Florida-Medical-Center-Clinic-P; Pensacola (FL); On-site; USD 42,000 - 54,000; Full time

Job summary

West Florida Medical Center Clinic is seeking a Managed Specialist to obtain preauthorizations for inpatient and outpatient procedures and to manage charge processing to support the billing cycle.

You will work with the Revenue Integration Manager, track requests, and ensure adherence to insurer requirements. Strong communication, accuracy, and team collaboration are essential.

Qualifications

• High school diploma or equivalent required.
• Medical billing/insurance experience preferred.
• Minimum 1 year of customer service experience.

Responsibilities

• Obtain preauthorization for inpatient admissions, outpatient surgeries and imaging.
• Track requests and prioritize with the Managed Care Worklist.
• Communicate professionally with medical offices and staff.
• Maintain up-to-date preauthorization matrices and carrier requirements.
• Stay current on insurer requirements through CE and research.
• Assist medical offices with questions on authorizations.
• Analyze data to recommend process improvements.
• Provide feedback on authorization requests to managers.
• Understand impact on billing and participate in process improvements.

Skills

Customer service

Interpersonal skills

Attention to detail

Communication (verbal/written)

MS Office proficiency

English proficiency

Problem solving

Teamwork

Education

High school diploma or equivalent

Tools

PPP

Horizon System

Microsoft Excel

Microsoft Word

Job description

Description

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.

Requirements

EDUCATION/EXPERIENCE REQUIREMENTS

• Minimum education requirement is high school diploma, or equivalent.
• Medical billing/insurance experience preferred.
• Minimum 1-year customer service experience.

KNOWLEDGE, SKILLS AND ABILITIES

• Ability to prioritize and manage multiple tasks.
• Displays customer services skills, strong interpersonal skills, close attention to detail, excellent verbal and written communication skills, and basic math skills. Good organizational skills and ability to adapt to frequent changes.
• Be a person of integrity and character, willing to embrace change and make a positive impact in the lives of patients and co-workers.
• Ability to work with staff members at all levels of the organization in a cooperative, team-oriented manner.
• Displays computer proficiency (i.e. PC Windows, MS Office) and ability to quickly learn new applications.
• Proficient in use of English language both in written and verbal communication.
• Must be able to communicate with individuals of varying socio-economic backgrounds.
• General overall understanding of other MedPro services department functions.
• Good understanding of complete charge cycle, including charge entry, all aspects of insurance billing and collections and the self-pay process.
• Must be committed to the protection of confidential information, records and/or reports.
• Possess strong critical thinking and analytical skills.
• Proficient in use of the following computer / software applications: PPP, Horizon System, Microsoft Excel and Word.

PHYSICAL REQUIREMENTS OF THE ESSENTIAL JOB FUNCTIONS

• Strength (Lift/Carry/Push/Pull): Sedentary (exerting up to 10 pounds of force occasionally)
• Standing/Walking: Occasionally; activity exists up to 1/3 of the time
• Keyboarding/Dexterity: Frequently; activity exists from ¾ of the time
• Ability to look at a computer screen for extended periods.
• Ability to perform constant repetitive hands and finger motions.
• Ability to maintain focus while working in close proximity to others.
• Talking (Must be able to effectively communicate verbally): Yes
• Seeing: Yes
• Hearing: Yes

EMOTIONAL REQUIREMENTS OF THE ESSENTIAL JOB FUNCTIONS

• Must exhibit stable work behaviors daily.
• Must possess adequate individual coping skills.
• Ability to remain calm and professional regardless of workload or time constraints.
• Must be able to work under stress and remain calm and professional.

WORK ENVIRONMENT

• Office environment.
• Exposed to frequent and constant interruptions in daily functions/schedule.
• May be required to work extended hours to meet department needs.