Managed Care Representative I

Job Locations US-FL-Jacksonville
ID 2022-1296
Category
Managed Care
Position Type
Regular Full-Time

Overview

Job Summary:

  • Facilitates resolution of contract variances and other contract discrepancies.  Works project appeals as assigned by Managed Care Leadership.  Monitors status of appeals for second level appeal submission.  Maintains contract files.

Responsibilities

Essential Functions and Tasks:

  • Identifies and resolves contract variances, which may include working with other departments internally; working directly with payers; and reviewing contract language/rates.
  • Answers questions and provides managed care related guidance to other departments within our organization.
  • Submits project appeals related to contract performance issues for all specialties.

Qualifications

Education and Experience Requirements:



  • High School Diploma or equivalent.

  • One (1) year of experience in medical billing or equivalent experience. 


Knowledge, Skills, and Abilities:



  • Knowledge of State, Federal, and Managed Care regulatory guidelines

  • Knowledge of benefit insurance billing contract management

  • Strong oral, written, and interpersonal communication skills

  • Strong decision-making skills

  • Strong problem-solving skills

  • Strong time management skills

  • Basic word processing, spreadsheet, database, and presentation software skills

  • Basic mathematical skills in addition, subtraction, multiplication and division of whole numbers and fractions; computing percentages; and working with decimals

  • Ability to read, understand, and apply state/federal laws, regulations, and policies

  • Ability to exercise sound judgment and handle highly sensitive and confidential information appropriately

  • Ability to remain flexible and work within a collaborative and fast paced environment

  • Ability to communicate with diverse personalities in a tactful, mature, and professional manner


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