Managed Care Specialist

Managed Care Specialist

Requirements

• Maintain a working knowledge of payer requirements for proper scheduling and authorizations.
• Effectively communicate via written, verbal, in person and virtual methods.
• High School Diploma or GED required.

Responsibilities

• Responsible for reviewing the daily reports for no authorizations and works to resolve the issue.
• Responsible for reviewing the daily service activity failures with regard to authorizations and works to resolve.
• Provide assistance to others in determining appropriate coverage and scheduling properly credentialed/licensed providers.
• Obtain benefit information and set up coverage information within the IT systems to ensure proper billing within 48 hours of date of service.
• Update and maintain notes regarding insurance verification and changes that may have occurred.
• Responsible for processing of denials due to no authorizations received and works to resolve discrepancies with insurance companies.

Preferred Qualifications

• Three to five years administrative experience preferred.