Managed Care Supervisor supervises and coordinates activities of personnel in the managed care operations department of a healthcare facility. Oversees staff that process referrals, authorizations, billing, utilization review, and capitation for hospital services. Being a Managed Care Supervisor experienced in utilization review techniques and protocols. Requires a bachelor's degree. Additionally, Managed Care Supervisor typically reports to a manager or head of a unit/department. May require Registered Nurse (RN). Makes day-to-day decisions within or for a group/small department. Has some authority for personnel actions. The Managed Care Supervisor supervises a group of primarily para-professional level staffs. May also be a level above a supervisor within high volume administrative/ production environments. To be a Managed Care Supervisor typically requires 3-5 years experience in the related area as an individual contributor. Thorough knowledge of functional area and department processes. (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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