Managed Care Coordinator coordinates utilization reviews of managed care contracts using established guidelines and processes. Ensures all clinical operations comply with Medicare and Medicaid guidelines and other managed care policies. Being a Managed Care Coordinator communicates with physicians, discharge planners and others to process referrals, authorization for services, and capture data related to utilization. Maintains managed care contracts and information databases and prepares reports. Additionally, Managed Care Coordinator typically requires an associate degree in nursing. Typically reports to a supervisor or manager. Typically requires Registered Nurse (RN). The Managed Care Coordinator has gained full proficiency in a broad range of activities related to the job. Independently performs a wide range of complex duties under general guidance from supervisors. To be a Managed Care Coordinator typically requires 5-7 years of related experience. (Copyright 2024 Salary.com)
Managed Care Network, Inc., is a growing company headquartered in Niagara Falls, New York, which offers claim administration support services to Property & Casualty Insurance Carriers throughout New York State.
MCN strives to be the best in the P&C marketplace by providing our customers with responsive service, innovative solutions, and high-quality outcomes. We take pride in our work and our company, and for being viewed as a reliable and dependable partner for our customers. We value our customers each and every day and in everything we do.
This specific position is for a Certified Professional Coder with Management experience.
Due to significant growth, we have an exciting position for a growth minded individual who has proven management skills.
Training will be provided. However, the successful candidate MUST possess the following qualities to meet training requirements.
Qualifications:
· Candidate must be a Certified Professional Coder (CPC)
· High level of integrity, attention to detail, dependable
· Excellent reading, writing, and verbal communication skills
· Analytical and researching skills
· Excellent computer skills, including Microsoft Office - Word, Outlook, and Excel.
· Able to meet deadlines
· Must have an excellent, pleasant, and persuasive communication style both verbally and in written form.
· Effective time management skills
· Excellent interpersonal, coaching and conflict resolution skills
Education & Experience:
· Certified Professional Coder (CPC) Certification
· Certification in Medical Coding
· Comprehensive Knowledge of International Classification of Diseases (ICD-10)
· Experience with Workers Compensation, No-Fault Insurance Medical Bills, Diagnosis Related Groups (DRGs) and Enhanced Ambulatory Patient Groups (EAPGs)
· Previous experience in a leadership role
Job Duties and Responsibilities
· Reviewing medical bills and auditing those bills for validity and accuracy
· Comply with various fee schedules
· Produce due date lists, and manage inventory
· Review trends and outcome reports
· Ensure coding and charges are supported by appropriate clinical documentation
· Write legally sound affidavits to be submitted for arbitration and litigation purposes
· May have to testify in relation to an audit or affidavit they have written.
· Oversee and build our Bill Review department to assist with provider fee scheduling for the workers comp and auto payers
· Manage a team of certified nurse coders, bill review specialist, and attorneys who evaluate and negotiate provider and facility bills in order to ensure proper payment amounts for the Payers.
· Growth minded leader to expand services, develop processes, and increase revenue
· Attend Level 2 meetings and be prepared to discuss trends, work load, projections, challenges etc.
· Manage the closeout of month end and work with accounting to ensure we are ready to bill monthly
· Manage department calendar and time off in accordance with company policy.
Work Location:
Must be a New York State Resident
Hybrid; Remote is available
License/Certification:
Shift availability:
Job Type: Full-time
Pay: $70,000.00 - $85,000.00 per year
Benefits:
Experience level:
Schedule:
License/Certification:
Ability to Relocate:
Work Location: Hybrid remote in Niagara Falls, NY 14303
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