Managed Care Representative I

Physicians East•Greenville, NC

5h•Onsite

About The Position

The Managed Care Representative I position is responsible for maintaining incoming and outgoing authorizations and referrals for multiple departments and specialties within Physicians East. Managed Care Representatives are responsible for reviewing Request for Authorization forms and ensuring that Orders are in the patient’s charts as well as the diagnosis is present on the form, prior to contacting the Insurance Company. Managed Care Representatives review insurance and check to make sure it is active, contacts the insurance company to verify benefits and ask if Authorization is needed for a procedure, drug, or surgery. If Authorization is needed, the Managed Care Representative is responsible for recording this along with any needed reference information and submitting the form to the appropriate person/department. Managed Care Representatives are required to document forms completely and appropriately if denials are received.

Requirements

High School Diploma is required
Experience in a medial office environment is required
Medical Terminology is required
Must have strong computer experience
Minimum of one year of patient/public contact experience
Must have a strong sense of team commitment, which includes meeting deadlines, punctuality and excellent follow-through and feedback.
Must display a high level of confidentiality, integrity, and initiative.
Ability to form positive and collaborative relationships with peers and physicians at all levels within the company.
Must possess exceptional interpersonal communication skills and can create a favorable impression for the organization to all staff, patients, and the public

Nice To Haves

Associates Degree is preferred
Minimum of one year of Managed Care Insurance experience is preferred

Responsibilities

Maintain & process incoming and outgoing authorizations for assigned department(s) and help with STATS and authorizations for team members during times out of the office.
Communicate with Providers and Clinical team when orders are not in and/or additional information is needed to submit for authorization.
Research “Non-authorized” denials and obtain retroactive authorizations when applicable.
Communicate with scheduling team(s) when procedures have not been approved for preauthorization.
Provide inter-departmental authorizations and internal referrals.
Obtain prior approval authorizations for specialists performing test or procedures. Clinical staff or scheduling personnel are responsible for notifying the Managed Care Representative when procedures or outside testing is needed.
Obtain in-patient authorization or precertification for hospital admissions.
Notify appropriate personnel of any changes required by insurance companies.
Route applicable procedures to the Cost Estimates team.
Provide coverage for managed care co-workers during vacation, sickness, leave of absence, etc.