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)
Cassena Care is seeking a Managed Care Medical Biller to join our dynamic team of professionals.
responsibilities include but are not limited to:
Collect, enter and process primary and/or secondary claim information on departmental cycle for multiple SNF locations.
Monitor verifications and authorizations obtained and ensure complete service spans are covered.
Answer business office manager and/or responsible party inquiries on account status and charges.
Researches and resolves all zero payment explanations or benefits and exercises all options to obtain claims payments; initiates adjustments as necessary.
Timely submission of SNF claims to various insurance companies
Prepares and generates clean claims for submission to all payor types, including third party payors, Medicare and Medicaid.
Develop and maintain working relationships with internal/external providers to ensure billings and collections procedures are current.
Monthly billing for all Commercial and Managed Care plans
Oversee authorization process to ensure accuracy
Create deposits weekly
Post cash to resident ledgers weekly
Follow up on all outstanding A/R
Qualifications:
High School Diploma/GED or equivalent required; Associates Degree or Medical Billing Certificate preferred.
Experience in area of billing, denials review, and accounts receivable processes required.
Medicaid and Managed Care Billing Experience
What we offer: Our organization offers employees far more than just a place to work. Rather, we are a company you can be proud of, where you’ll feel good about devoting your time and your talents.
Salary commensurate with experience
Generous PTO package
Health/Dental Benefits
401k plan
We are an EOE
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