Managed Care Specialist
Managed Care Specialist
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Job Description
Job Summary
Completes timely and accurate determination of contracted payor underpayments. Submits timely requests for reprocessing and followup of underpaid claims for contracted payors. Provides detail regarding the root cause of underpayments and offers actionable recommendations where appropriate to eliminate future underpayments. .
Essential Functions
- Researches and analyzes issues related to underpayments by contracted payors.
- Trends underpaid scenarios and coordinates collections with payors and internal stakeholders making recommendations for potential solutions resulting in continuous quality improvement. Collects underpaid accounts by various methods but not limited to the following: emails phone calls and meetings with payors.
- Develops relationship with payors to ensure open communication regarding issues arising from underpayments.
- Maintains expert knowledge of contracts and their reimbursement methodologies.
- Provides feedback to contract loading specialists regarding inaccurate contract build.
- Provides underpayment collections training or assistance as needed to peers.
- Meets and/or exceeds quality productivity and collection standards.
- Makes presentation to groups of individuals of up to 15 people.
Physical Requirements
Work requires sitting walking and lifting throughout the day. Must be able to lift up to 10 lbs.
Education Experience and Certifications
High School Diploma or GED required; Bachelors Degree preferred. Experience with Microsoft Office Claims Processing at an insurance or managed care organization required. Patient accountant experience preferred. Understands DRG APDRG ICD9 HCPC and CPT. Excellent oral and written communication skills.
Our Commitment to You:
Advocate Health offers a comprehensive suite of Total Rewards: benefits and wellbeing programs competitive compensation generous retirement offerings programs that invest in your career development and so much more so you can live fully at and away from work including:
Compensation
Annual Base Pay: $58344.00$87568.00
- Base compensation listed within the listed pay range based on factors such as qualifications skills relevant experience and/or training
- Premium pay such as shift on call and more based on a teammates job
- Incentive pay for select positions
- Opportunity for annual increases based on performance
Benefits and more
- Paid Time Off programs
- Health and welfare benefits such as medical dental vision life and Short and LongTerm Disability
- Flexible Spending Accounts for eligible health care and dependent care expenses
- Family benefits such as adoption assistance and paid parental leave
- Defined contribution retirement plans with employer match and other financial wellness programs
- Educational Assistance Program
Visit access your existing Total Rewards and view thisFAQto learn more about the internal transfer process.
Required Experience:
Unclear Seniority
Employment Type
Full-Time
