PROVIDER NETWORK MANAGER jobs in Buffalo, NY

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:

• Driver's License (Preferred)
• Certified Professional Coder (CPC)

Shift availability:

• Day Shift (Required)

Job Type: Full-time

Pay: $70,000.00 - $85,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Health insurance
• Health savings account
• Life insurance
• Paid time off

Experience level:

• 5 years

Schedule:

• 8 hour shift
• Monday to Friday

License/Certification:

• Certified Professional Coder (Required)

Ability to Relocate:

• Niagara Falls, NY 14303: Relocate before starting work (Required)

Work Location: Hybrid remote in Niagara Falls, NY 14303