Managed Care Coordinator

Company: Overlook Community and VNA/Hospice
Location: Sunderland
Posted on: May 15, 2022

Job Description:

Job DescriptionPosition Title: Managed Care CoordinatorFLSA STATUS: Non-Exempt REPORTS TO: Patient Account Manager POSITION SUMMARY:The Managed Care Coordinator is responsible for processing health care authorizations for insurance companies, who performs specific duties for the OVNA and Overlook Hospice. These duties include, but are not limited to, obtaining authorizations in a timely manner and follow up of authorizations according to established billing policies.THE OVERLOOK WAY:Culture of Excellence and Core Values:All Team Members of The Overlook must embrace and conduct themselves at all times in support of the company's 28 Guiding Principles and core values, which form the foundation of our unique culture.

• Integrity: saying what you mean, meaning what you say (in action and words), even if it hurts you personally or professionally
• Respect for Individual Choice: empowering and supporting others in their Self-determination for health and well-being, as they define it
• Compassion: understanding and sympathetic of others
• Creativity/Innovation: thinking wildly, planning accordingly
• Grace: putting people at ease, without compromising performance or outcomes PRINCIPLE DUTIES/ESSENTIAL FUNCTIONS:
• Obtain initial authorizations according to each individual's insurance company's process and policies.
• Process all authorizations submitted by clinicians in a timely manner with the appropriate documentation required. Reports late submission by clinical staff to the Patient Accounts Manager.
• Track all pending authorizations and follow-up on outstanding authorizations according to company guidelines and established procedures.
• Reports and documents any denials, or insurance issues to the prospective branch and billing representative.
• Responsible for uploading authorization information to patient charts as procedures indicate.
• Works cooperatively as a productive member of the Corporate Billing team.
• Works to achieve timely and accurate authorizations through good communication, problem solving, multitasking and organizational skills.
• Participates in webinars and recommended educational programs offered by insurance companies as advised by the Patient Accounts Manager.
• Participates in billing meetings and is prepared to present any current authorization issues, updates and concerns pertaining to the authorization process.
• Courteously receives and answers applicable authorization related inquiries through verbal or written correspondence with team members, clinical staff, branch members and insurance carriers.
• Has an organized, efficient system for follow up of outstanding and/or pending authorizations.
• Works as a team member, and ensures authorization requests are completed on a daily basis.
• Works closely with clinical staff of assigned organizational location to assure thorough, complete, and accurate authorizations are submitted.
• Communicates clinically with insurance companies as needed to offer information and clarity, ensuring the required information is provided utilizing clinical resources as needed.The above statements are only meant to be a representative summary of the major duties and responsibilities expected by incumbents of this job. The incumbents may be requested to perform job-related tasks in addition to those stated in this description. QUALIFICATIONS:
  • Two years of Healthcare Billing Experience
  • Knowledge of the insurance qualifying guidelines for homecare services
  • Computer proficiency (understanding of the Windows environment, Excel, MS Office, and the ability to learn how to navigate various website portals for insurance companies)
  • Excellent organizational skills
  • Ability to read, write and speak the English language
  • Ability to Multitask, prioritize and handle some stressful situations
  • Ability to work under pressure and meet deadlinesPHYSICAL REQUIREMENTS/WORKING CONDITIONS:Primary work will be performed in doors in an office setting, may be exposed to the elements (heat, cold); walking and standing frequently; occasional lifting of up to 25 pounds. Located on a beautiful 450 acre campus in Charlton, Massachusetts, The Overlook Retirement Community and Health Center offers 221 independent living residences and a complete continuum of care including post-acute, assisted living, memory care, CARE management services, and skilled nursing for long and short-term care needs. The Overlook sponsored by the Masonic Health System of Massachusetts has a proud tradition of service since 1911.We are an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender identity and/or expression, national origin, protected veteran status, disability, genetics and will not be discriminated against on the basis of such characteristics or any other status protected by the laws or regulations in the locations where we operate. We encourage all applicants of all ages.Powered by JazzHRkiIyP7a3nZ

Keywords: Overlook Community and VNA/Hospice, Springfield , Managed Care Coordinator, Other , Sunderland, Massachusetts